FamilyMedicineExamQsSamples

M.MED.
FAMILY MEDICINE
II YEAR THEORY EXAM– AUG 2013
PAPER IV - FAMILY MEDICINE AND PRIMARY CARE
TIME: THREE HOURS MAXIMUM MARKS: 100
INSTRUCTIONS
• The paper will be for a total of 100 marks.

• Answer all the Questions.
• The Paper has 2 parts – Part A & Part B.
• Part A will be descriptive type questions based on case scenarios (40 marks).
• Part B will have Objective type EMQs extended matching questions (60 marks).
9 This will have 10 sets of these questions.
9 Each set will have 6 questions.
9 Each question will carry 1 mark.
9 Each set has a theme on the top. In each set there are some options given on the top followed
by some questions. The options are lettered using the English Alphabets A, B, C, D and so
on.
Example:
3. THEME –COMMON PSYCHIATRIC PROBLEMS [QUESTIONS. 3(i) – 3(vi)] (6marks)
From the options ‘A to H’ given below, choose the best answer for the questions 3(i) – 3(vi)
Options:
A. Inj. Haloperidol
B. Amitriptyline + counseling
C. Tab. Chlorpromazine
D. Tab. Trihexyphenidyl
E. Tab. Diazepam
F. Tab. Lithium
G. Inj. Fluphenazine deconoate
H. Tab. Risperidone
Questions: What is your treatment option in the following cases?
3(i) What is the drug of choice for Acute Psychosis?
3(ii) What is the drug of choice for Bipolar illness?
PART – A
DESCRIPTIVE QUESTIONS
(ANSWER ALL QUESTIONS)
1. 46 year old Mr. Manichand comes to you with a Urinary tract infection and on investigating
him, you find that his blood sugars are very high. On questioning, Mr. Manichand says that, 4
years ago, he was told that his sugars were high, but he did not take any medicines except some
herbal tonic he drinks everyday since then which is supposed to reduce blood sugar level. He has
never checked his blood sugars in between. You send him for further investigations to look for
complications. He is found to have Retinopathy for which he needs Laser therapy and his
creatinine is 2mg/dl.
(TOTAL: 20 MARKS)
A. What are your roles as a Family Physician in treating Mr. Manichand? (5 Marks)
B. Describe in detail the principles of Chronic Disease follow-up and how you will apply it to
Mr. Manichand. (10 Marks )
C. How will you counsel Mr. Manichand regarding his problems, the possible solutions and
further treatment plan? (5 Marks )
2. Mr. Hari who met with an accident on a highway is brought to your clinic. He was found be
conscious and his blood pressure was 70/ 50 mm of hg and he was bleeding profusely from the
fractured left leg.
(TOTAL: 20 MARKS)
A. Explain the principles of ‘referral in Family Practice’ and how you will apply it to Mr.
Hari? To where and to whom will your refer him? (12 Marks )
B. Write a referral letter for Mr. Hari (8 Marks )
PART – B
EXTENDED MATCHING QUESTIONS
1. THEME: TYPES OF REFERRALS [QUESTIONS. 1(i) - 1(vi) (TOTAL: 6 MARKS)
From the options ‘A to D’ given below, choose the best answer for the questions 1(i) – 1(vi)
Options :
A. Interval Referral C. Split Referral
B. Collateral Referral D. Cross Referral
Questions: What is the type of referral which is described in the following cases?
1.(i). Mr. Ganesh is seen by you for complaints of acute abdominal pain and you refer him to
a surgeon for Appendectomy.
1.(ii). Mr. Prakash , whom you are treating for diabetes has developed retinopathy and you
refer him to an ophthalmologist for Laser therapy.
1(iii). You find that Mrs. Parvathy, who is being taken care of by you in your antenatal clinic,
has a valvular heart problem and you refer her to a cardiologist for opinion and treatment.
1.(iv). Mr. Raja comes to you with a compound fracture of his forearm. You refer him to an
Orthopedician for an open reduction.
1.(v). Ms. Suja goes to a doctor with head ache for 2 months and the doctor referred her to an
ophthalmologist, Neurophysician, ENT specialist and a Psychologist for checkup.
1.(vi) In your antenatal clinic, you do an ultrasound for Mrs. Shyama who is an elderly primi
and find that she has a large fibroid complicating pregnancy. You refer her to a
Gynaecologist for further care and safe delivery.
2. THEME: RED FLAGS [ QUESTIONS 2(i) – 2(vi)] (TOTAL: 6 MARKS)
From the options ‘A to B’ given below, choose the best answer for the questions 2(i) - 2(vi)]
Options :
A. Red Flag for Backache
B. Not a Red Flag for backache
Questions: Choose from the Options below which of the following is and which is not a red
flag for Backace
2(i). Age of 58
2(ii). Persistent fever
2(iii). History of cancer
2(iv). Unremitting night pain
2(v). Cauda Equina syndrome
2(vi). Early morning pain

3. THEME: MALARIA PROPHYLAXIS [QUESTIONS. 3(i) – 3(vi)]
(TOTAL: 6 MARKS)
From the options ‘A to J’ given below , choose the best answer for the questions 3(i)– 3(vi):
Options :
A. Tab. Chloroquine 300 mg base same day each week 1 wk before, during, 4 wk after
exposure at 10 weeks
B. Tab. Chloroquine 600 mg base same day each week 1 wk before, during, 4 wk after
C. Cap Doxycycline100 mg same day each week, 1 wk before, during, 4 weeks after
D. Tab. Chloroquine 150 mg base same day each week 1 wk before, during, 4 wk after
E. Tab. Mefloquine 500 mg same day each week
F. Tab Proguanil 200 mg (2 tabs) same day each week 1 day before, during, 4 weeks after
G. Tab. Mefloquine 750mg same day each week
H. Tab Proguanil 100 mg (1 tab) same day each week 1 day before, during, 4 weeks after
I. Tab Proguanil 50 mg ( ½tabs) same day each week 1 day before, during, 4 weeks after
J. Cap Doxycycline 200 mg each day, 2 days before, during, 4 weeks after
Questions:
3(i) . Mr. Manoj is going for an official assignment to Bihar and you want to start
Chloroquin prophylaxis for him. Which regime will you follow?
3(ii). Mina is going to a malaria-prone area for her work for 5 weeks and you know that it is
a chloroquin resistant area. What will be your alternative drug and its dose?
3(iii). Mina is also taking her 3 year old son with her to that chloroquin resistant malaria-
prone area? What will be your drug of choice and its dose?
3(iv) . Monisha went to a malaria-prone area and he was given malaria prophylaxis, but that
drug caused photosensitivity reaction. What drug can it be?
3(v) . 32 year old Subash , a business executive is attending a 1-week conference in Brazil
which also involves some field trips. What will be your drug of choice and its dose?
3(vi) Which of the above drugs can be used only on a person who has a body weight of
above 45 kg?
4. THEME: OVERUSE SYNDROMES OF LEGS [QUESTIONS. 4 (i) – 4(vi)] (TOTAL:
6 MARKS)
From the options ‘A to F ’given below, choose the best answer for the questions 4 (i )–
4(vi)]:
Options :
A. Plantar Fasciitis D. Tibial stress fracture

B. Ilio-tibial band tendinitis E. Anterior compartment syndrome
C. Tibila stress syndrome F. Achilles tendinitis
Questions: Name the correct sites of the overuse syndromes of the leg in the picture given
below:
4(i).
4(v).
4(ii). 4(v).
4(vi).
4(iv).
4(iii).
5. THEME: ANKLE LIGAMENT INJURIES [QUESTIONS. 5(i) – 5(vi)] (TOTAL:
6 MARKS)
From the options ‘A to D’ given below, choose the best answer for the questions . 5(i)–5(vi):
Options :
A. Anterior Talo-Fibular (ATFL)

B. Calcaneo-Fibular Ligament (CFL)
C. Posterior talofibular ligament (PTFL)
D. Medial Ligament
Questions:
5(i). Farah, an athelete slipped from the stairs and her right foot went into inversion in a
plantar flexed state. Which ligament is she most likely to injure?
5(ii). Mohan, a basketball player, slipped in the court and his right foot went into inversion in
a neutral position. Which ligament is he most likely to injure?
5(iii). Mr. Raman twisted his ankle while he was skiing. The ankle went into inversion while
the foot was in dorsiflexion. Which ligament is he most likely to injure?
5(iv). Sharda twisted her ankle while she was skipping. Her ankle went into eversion while
the foot was in a plantar-flexed state. Which ligament is she most likely to injure?
5(v). Mayank twisted his ankle while he was playing football. His ankle went into eversion
while the foot was in a neutral state. Which ligament is she most likely to injure?
5(vi). Which is the most common ligament to be injured in inversion injuries of the ankle?
6. THEME – CHRONIC DISEASE FOLLOWUP [QUESTIONS. 6(i) – 6(vi)] (TOTAL:
6 MARKS)
From the options ‘A to F’ given below, choose the best answer for the questions 6(i) – 6(vi)
Options:
A. Screening and Early detection D. Coordinating care with specialists
B. Ensuring compliance E. Promoting self-capacity of patient
C. Looking for complications F. Patient and carer education
Questions:
6(i). What is the first step in chronic disease follow up?
6(ii). Dr. Pai uses a paper based register recall system for followup his diabetic patients.
Which aspect of chronic disease follow-up he is focusing on?
6(iii). Dr. Dinakar send a nurse for home-visits to all his patients with coronary artery
disease. Which aspect of chronic disease follow-up he is focusing on?
6(iv). Dr. Dutta has employed a nurse educator to teach SMBG (Self-Monitoring of Blood
Glucose) to his diabetic patients. Which aspect of chronic disease follow-up he is
focusing on?
6(v). Dr. Nesan does monofilament testing for his diabetic patients on a routine basis. Which
aspect of chronic disease follow-up he is focusing on?
6(vi). Dr. Manjukar has a volunteer team in OPD to have focus group discussions for patients
with diabetes and their relatives. Which aspect of chronic disease follow-up he is
focusing on?
7. THEME – TEAM CONCEPT – CLINICAL ASSISTANT [QUESTIONS. 7(i) – 7(vi)]
(TOTAL: 6 MARKS)
From the options ‘A to B’ given below, choose the best answer for the questions 7(i) – 7(vi)
Options:
A. Clinical Assistant
B. Clinical Assistant with Physician
Questions: Which of the following can be done by the clinical assistant alone and which ones
he has to do along with the Physician ?
7(i) . Ask appropriate questions for the problems or symptoms, using the “ODD IF HAPPY”
mnemonic.
7(ii). Review problem list and get patient's update on recent problems
7(iii). Recommend and document appropriate preventive care plan
7(iv). Performs pertinent physical exam and communicates findings.
7(v). Administer MMSE (Mini Mental State Examination)
7(vi). Writes down impressions and plan.

8. THEME: GOVERNMENT PROGRAMS [QUESTIONS. 8(i) – 8(vi)]
(TOTAL: 6 MARKS)
From the options ‘A to L’ given below, choose the best answer for the questions 8(i) –
8(vi)]
Options:
A. Kala Azar control program G. Integrated Child Development Services
Scheme
B. Dengue and Chikungunya control
H. RNTCP Revised Natiuonal TB Control
program
Program
C. National AIDS control program I. Reproductive and Child Health Program
D. Malaria control program (RCH)

J. Kishori ShakthiYojana (KSY)
E. Special Nutrition Program
K. JSY (Janani Suraksha Yojana)
F. Mid-day meal program L. RSBY (RashtriyaSwastyaBimaYojana.)
Questions: Identify to which Government program , each of the following components is

part of:
8(i). Promotion of Institutional delivery
8(ii). Vector control through IRS with DDT up to 6 feet height from the ground twice
annually
8(iii). Prevention of Parent to child transmission of disease is done

8(iv). Supplementary feeding of about 300 calories and 10 grams of protein to preschool
children and about 500 calories and 25 grams of protein to pregnant and breastfeeding
mothers for six days a week.
8(v). Indoor insecticide spray in endemic areas
8(vi). Indoor insecticide spray during epidemic months of June/July
9. THEME – CHARACTERISTICS OF A FAMILY PHYSICIAN
[QUESTIONS. 9(i) – 9(vi)] (TOTAL: 6 MARKS)
From the options ‘A to G’ given below, choose the best answer for the questions 9(i) – 9(vi)
Options:
A. Whole person care E. A command of complexity and

uncertainty
B. Comprehensiveness
F. High level of Diagnostic and
C. Disease centeredness
therapeutic skill
D. Continuity of care
G. Coordinated care
Questions: Which aspect of Family Medicine do the following cases portray?:
9(i). Mr. Shankar came with headache to you. You take a good history and do complete
clinical examination and diagnose it to be a tension headache. You spend time with
Shankar and find out that he has marital problems and you advise him and his wife to go
for marriage counseling.
9(ii). Malini has come with knee swelling and you on investigations find out that she has
osteosarcoma. You call up an orthopedician and talk to him about her and send her to him
with a referral letter.
9(iii). Mr. Salim has come to you for the first time. He is a diabetic and takes medicines from
different doctors irregularly. You examine him, order relevant investigations and make a
followup plan for him.
9(iv). Mr. Lal is diagnosed with TB. You start him on ATT. He is also bothered about his
osteoarthritis for which you give medications and teach him exercises. You ask him to
bring his 3 year old granddaughter who lives in the same house for screening for TB.
9(v). Mrs. Munni comes to you with cough and fever for 2 days. You find on examination
that her radial pulse rate- 90/min, B.P-100/70mmHg and respiratory rate is 28/min. You
suspect that she has pneumonia and start her on antibiotics. You defer doing an X-ray
despite her son being keen on it. She comes o you well in 2 days’ time.
9(vi). You call an ophthalmologist friend of yours to come once in 2 months and check your
diabetic patients who are due for an ophthalmoscopy for diabetic retinopathy.
10. THEME – MEDICAL DOCUMENTATION [(QUESTIONS. 10(i) – 10(vi)]
(TOTAL: 6 MARKS)
From the options ‘A to B’ given below, choose the best answer for the questions 10(i) –
10(vi)
Options:
A. True
B. False
Questions:
10(i) . A problem is anything that requires diagnosis or management or that interferes with
quality of life as perceived by the patient.
10(ii). Weed described four basic elements as the nucleus of the Source oriented medical
record (POMR) namely: Data base ,Problem list, Initial plan and Progress notes.
10(iii). There is no proof that sharing the record with the patient improves quality of care, but
it improves the patient’s understanding about the disease.
10(iv). Family practice record will have well-established diseases as well as symptoms at
undifferentiated stage of illness.
10(v). In Family practice records, minor problems that resolve but then recur with excessive
frequency may assume the status of major problems.
10(vi). Source oriented medical record (SOMR) is a diary of past events, consisting of
laboratory data, radiological reports, physicians’ reports, and consultants’ reports.
******
(LE 0214) M.MED.FAMILY MEDICINE Sub. Code: 4014
II YEAR THEORY EXAM– FEB 2014
Q.P. CODE: 434014
TIME: THREE HOURS MAXIMUM MARKS: 100
INSTRUCTIONS

• Part B will have Objective type EMQs extended matching questions (60 marks).
9 Each set has a theme on the top. In each set there are some options given on the top followed
by some questions. The options are lettered using the English Alphabets A, B, C, D and so
on.
Example:
Options:
A. Inj. Haloperidol
E. Tab. Diazepam
F. Tab. Lithium
H. Tab. Risperidone
1
PART – A
1. You have a primary health care setup in a village. You take care of 6 villages with a total
population 8000. In the busy out patient days, you feel the quality of time you spend with
each patient is not satisfactory. (TOTAL: 20 MARKS)
A. If you train a clinical assistant to help you, what are the areas he can be helpful? Explain
each area briefly. (10 Marks)
B. What are the benefits of team care? (5 Marks )

C. Discuss any five qualities of a family physician as a team leader. (5 Marks )
2. You work in a village PHC where you find many adolescent girls with anemia and
married women with high risk pregnancy. (Total :20 marks)
A. What is the program that is targeted towards adolescent girls?
1. Who are the Beneficiaries
2. What are the Benefits of this program?
3. What are Common services
4. What are the Eligibility Criteria?
5. Explain briefly how to avail the benefits? (10 Marks )
B. Explain about one program that is targeted towards antenatal women under the
following headings..
1. Who are the Beneficiaries

2. What are the Benefits of this program?
3. What are Common services
4. What are the Eligibility Criteria?
5. Explain briefly how to avail the benefits? (10 Marks )
2
PART – B
1. THEME – Family physician as Leader [(QUESTIONS. 1(i) – 1(vi)]

(TOTAL: 6 MARKS)
From the options ‘A and B’ given below, choose the best answer for the questions 1(i) –
1(vi)
Options:
A. True
B. False
Questions:
1 (i) Dr.Sankar in the beginning of the week communicates to his whole team the tasks for the
weeks and delegates to them what each person has to do. It is a good leadership quality.
1 (ii) It is said of Dr.Daya that he talks a lot, but never keeps his word. Others in the team say
that though he is like that somehow he gets the work done by bribing people. Since he somehow
gets the work done, he can be called a good leader.
1 (iii) Dr. Ranjan shouts at people and gets the work done very easily. It is a good leadership
quality.
1 (iv) The local MLA wanted a false death certificate from Dr.Latha and she refused.In a few
days time she was transferred and her family had to suffer a lot. Lot of her seniors told that in the
present situation most of them oblige to what the politicians demand. In your opinion, Dr.Latha
is a good leader.
1 (v) Dr. Pushpa gets commission for all the investigations she sends from the nearby lab and
distributes it equally to all her employees. She is a good leader.
1 (vi) Dr. Kishore, reads journals, attends conferences ,participates in CMEs .Some people in the
team feel that it is waste of time. They feel he should see patients instead of doing these things.
What Dr. Kishore does is right.
3
2. THEME – CHARACTERISTICS OF A GOOD LEADER
Options:
A. Character E. Generosity
B. Commitment F. Listening
C. Good communication G. Self discipline
D. Courage H. Relationship
Questions: Which aspect of good leadership quality of a Family physician do the

following cases portray?:
2 (i) Dr.Mathan wakes up at 5am, does his morning exercise, reads for ½ an hour and will be in
the hospital sharp at 8a.m.In the evenings he plays for an hour and regularly reads for an hour.
2 (ii) The staff of the team wanted to tell their grievances to Dr. Babu. He was hearing it
patiently for more than an hour.
2 (iii) When there was an epidemic of cholera in their area. Dr.Kannan called all his staff and
explained to them all what need to be done and how they are going to do that etc
2 (iv) Mr. Kumar, the local Thasildar’s nephew had fever for 1day and demanded antibiotic and
Dr. Kamesh declined to prescribe from his PHC. Soon he got a threatening call from the
Thasildar that if he he may have to face dire consequences. Yet Dr. Kamesh did not oblige.
2 (v) 5 month old Preethi was brought with signs of meningitis and the mother had onlyRs.50
with her. Dr.Kumar paid for the ambulance and transferred the child to a secondary care hospital
40k.m away and gave rs.500 to the mother to be spent for her treatment.
2 (vi) Dr. Lalitha’s niece got married. She finished her antenatal clinic and attended the reception
though she could not be there for the wedding.
4
3. THEME – CHARACTERISTICS OF A FAMILY PHYSICIAN
Options:

uncertainty
B. Comprehensiveness
F. High level of Diagnostic and
C. Disease centeredness
therapeutic skill
D. Continuity of care
G. Coordinated care
3 (i) 27 year old Sumathi presented with high grade fever with right knee swelling and pain for
1day.Dr.mukesh suspected that she has septic arthritis and did a knee aspiration and sent it to lab
and confirmed the diagnosis. He started her on cloxacillin and now she is fine.
3 (ii) Dr. Ruby started Mr.Kannan on antihypertensive drugs and gave appointed after 15days to
see her to see how he responds to treatment.
3 (iii) 5 year old Rani has developmental delay. Dr.Ramanan has referred her to Dr.Kamal who
is a developmental Paediatrician and both of them followed her up.
3 (iv) Mrs. Sudha presented to you with aches and pains for the past 6months.On questioning her
you found that her main problem is due to her husband who is an alcoholic and giving lot of
trouble. You have called him and counseled him.
3 (v) You have called 20 diabetic patients under your care for Retinopathy check up by an
ophthalmologist.
3 (vi) Mr.Kannan has been diagnosed to have Lung cancer. Dr.Ramesh the pulmonologist is
worried about all the complications he may develop and advises expensive treatments , while the
family is struggling to make ends meet.
5
4. THEME – TEAM CONCEPT – CLINICAL ASSISTANT [QUESTIONS. 4(i) – 4(vi)]
(TOTAL: 6 MARKS)
From the options ‘A to B’ given below, choose the best answer for the questions 4(i) – 4(vi)
Options:
A. Clinical Assistant
Questions: Which of the following can be done by the clinical assistant alone and which ones
he has to do along with the Physician ?
4 (i) Functions by the mnemonic “ODD IF HAPPY”
4 (ii) Updates the problem list with dates of important completed tests (colonoscopy,
mammogram, etc.).
4 (iii) Reviews the impressions and plans with the patient and then politely exits, leaving the
hard copy of the impressions and plan
4 (iv) Performs pertinent physical exam and communicates findings.
4 (v) Explains matters of referral process or obtaining further tests at other facilities.
4 (vi) Documenst the impressions and plan of the physician
6
5. THEME – CHRONIC DISEASE FOLLOWUP [QUESTIONS. 5(i) – 5(vi)] (TOTAL:
6 MARKS)
Options:
A. Screening and Early detection
B. Ensuring compliance
C. Looking for complications
D. Coordinating care with specialists
E. Promoting self-capacity of patient
F. Patient and carer education
Questions:
5 (i) What is the first step in chronic disease follow up?
5(ii) Dr. Pai uses a- Electronic recall systems like PCICS to follow his diabetic patients. Which
5(iii) Dr. Dinakar sends Mr.Sankar with a diabetic foot with ulcer for debridement to a surgeon.
5(iv) Dr. Dutta has employed a nurse educator to teach self assessment of peakflow of all his
asthmatic patients. Which aspect of chronic disease follow-up he is focusing on?
5(v) Dr. Moorthy does monofilament testing for his diabetic patients on a routine basis. Which
5(vi) Dr. Manjukar has a volunteer team in OPD to have focus group discussions for patients
with diabetes and their relatives. Which aspect of chronic disease follow-up he is focusing on?
7
6. THEME-HOME VISIT [QUESTIONS. 6(i) – 6(vi)] (TOTAL: 6 MARKS)
Options:
A. Community based care
B. Home based care
C. Home care
D. Therapeutic home visit
E. Diagnostic home visit
F. Increased
G. Core value of Family medicine
H. Decreased
Questions:
6(i).Patient-Doctor relationship is a ……………
6(ii).Increasing costs, improvement in communication and emergency services has
caused……………. number of home visits.
6(iii).Ms. Padma a village health nurse visits Mr.Ramanand gives Inj.Procaine penicillin daily for 5
days.This is an example of ……………….
6(iv).Dr. Raman was called to see Mr.Gopal who was breathless.He examines him any says that
Mr.Gopal has acute exacerbation of asthma. This is an example of………………………..
6(v).Mrs.Rose the village health nurse visits Mr.Murugan,who was discharged from hospital after a
Myocardial infarction.What she does is ………………..
6(vi).Mr.Rajan who has developed a stroke is being taken care of by his wife and children.This is an
example of…………………
8
7. THEME: TYPES OF REFERRALS [QUESTIONS. 7(i) - 7(vi) (TOTAL: 6 MARKS)
Options :
Questions: What is the type of referral which is described in the following cases?
7.(i). Mr. Ganesh is seen by you for complaints of acute abdominal pain and you refer him to a
surgeon for Appendectomy.
7.(ii). Mr. Prakash , whom you are treating for diabetes has developed retinopathy and you refer
him to an ophthalmologist for Laser therapy.
7(iii). You find that Mrs. Parvathy, who is being taken care of by you in your antenatal clinic,
has a valvular heart problem and you refer her to a cardiologist for opinion and treatment.
7.(iv). Mr. Raja comes to you with a compound fracture of his forearm. You refer him to an
Orthopedician for an open reduction.
7.(v). Ms. Suja goes to a doctor with head ache for 2 months and the doctor referred her to an
ophthalmologist, Neurophysician, ENT specialist and a Psychologist for checkup.
7.(vi) In your antenatal clinic, you do an ultrasound for Mrs. Shyama who is an elderly primi
and find that she has a large fibroid complicating pregnancy. You refer her to a Gynaecologist
for further care and safe delivery.
9
8. THEME: GOVERNMENT PROGRAMS [QUESTIONS. 8(i) – 8(vi)]
(TOTAL: 6 MARKS)
8(vi)]
Options:
Scheme
B. Dengue and Chikungunya control
H. RNTCP Revised Natiuonal TB Control
program
Program
C. National AIDS control program I. Reproductive and Child Health Program
D. Malaria control program (RCH)

J. Kishori ShakthiYojana (KSY)
E. Special Nutrition Program
K. JSY (Janani Suraksha Yojana)

part of:
8(i). Promotion of Institutional delivery
8(ii). Vector control through IRS with DDT up to 6 feet height from the ground twice annually
8(iii). Prevention of Parent to child transmission of disease is done
8(iv). Supplementary feeding of about 300 calories and 10 grams of protein to preschool children
and about 500 calories and 25 grams of protein to pregnant and breastfeeding mothers for six
days a week.
8(v). Indoor insecticide spray in endemic areas
8(vi). Indoor insecticide spray during epidemic months of June/July
10
9. THEME – MEDICAL DOCUMENTATION [(QUESTIONS. 9(i) – 9(vi)]
(TOTAL: 6 MARKS)
From the options ‘A to B’ given below, choose the best answer for the questions 9 (i) – 9 (vi)
Options:
A. True
B. False
Questions:
9(i) . A problem is anything that requires diagnosis or management or that interferes with quality
of life as perceived by the patient.
9(ii). Weed described four basic elements as the nucleus of the Source oriented medical record
(POMR) namely: Data base ,Problem list, Initial plan and Progress notes.
9(iii). There is no proof that sharing the record with the patient improves quality of care, but it
improves the patient’s understanding about the disease.
9(iv). Family practice record will have well-established diseases as well as symptoms at
undifferentiated stage of illness.
9(v). In Family practice records, minor problems that resolve but then recur with excessive
frequency may assume the status of major problems.
9 (vi). Source oriented medical record (SOMR) is a diary of past events, consisting of laboratory
data, radiological reports, physicians’ reports, and consultants’ reports.
11
10. THEME – NUTRITIONAL PROGRAMS [(QUESTIONS. 10(i) – 10(vi)]
(TOTAL: 6 MARKS)
From the options ‘A to G ’ given below, choose the best answer for the questions 10(i) –
10(vi)
Options:
A. Integrated Child Development Services Scheme
B. Midday Meal Program
C. Special Nutrition Program (SNP)
D. National Nutritional Anemia Prophylaxis Program
E. National Iodine Deficiency Disorders Control Program
F. School Health program
G. Mountain dwellers health program
Questions:
10 (i) . Health screening and identifying children with problems like anemia, malnutrition, eye
problems and refer for treatment; Health Education for school children and teachers; Promoting
hygienic practices in schools like hand-washing
10 (ii). Aimed at school-going children by providing one meal per day at noontime with goals of
Improving the nutritional status of children; Encouraging poor children, to attend school more
regularly; Providing nutritional support to children of primary stage in drought-affected areas
during summer vacation.
10 (iii). It provides supplementary feeding of about 300 calories and 10 grams of protein to
preschool children and about 500 calories and 25 grams of protein to pregnant and breastfeeding
10 (iv). This program provides Supplementary nutrition, provision of Vit-A, Iron and Folic
Acid, Immunization, Health check-ups, Referral services, Treatment of minor illnesses; Nutrition
and health education to women; Pre-school education of children in the age group of 3-6 years.
10 (v). Under this program, the expected and breastfeeding mothers as well as acceptors of
family planning methods were also provided with iron and folic acid supplements.
10 (vi). Health education about managing endemic goiters; targeted at hilly areas
***
12
(LF 0214) M.MED.FAMILY MEDICINE Sub Code: 4014
II YEAR THEORY EXAM– AUGUST 2014
PAPER IV -FAMILY MEDICINE AND PRIMARY CARE
QP CODE: 434014
TIME: THREE HOURS MAXIMUMMARKS: 100
INSTRUCTIONS

• Part B will have Objective type EMQs [Extended Matching Questions](60 marks).
9 Each set has a theme on the top. In each set there are some options given on the top
followed by some questions. The options are lettered using the English Alphabets A, B,
C, D and so on.
Example:
Options:
A. Inj. Haloperidol
E. Tab. Diazepam
F. Tab. Lithium
H. Tab. Risperidone
9 Match each question to a single best option and write it in your paper in the column
provided like this: 3(i) A
3(ii) F
3(iii)
3(iv)
3(v)
3(vi)
9 Each option may be used more than once. Some options may not be used at all.
PART – A
1. Mr. Somnath admitted his wife in a private hospital for delivery. She was taken up for a
caesarean section 6 hours later because there was foetal distress. But the baby was
asphyxiated at birth and finally died after 2 hours despite being put on a ventilator. Mr.
Somnath has now filed a case under Consumer Protection Act against the hospital, citing
negligence at the District Consumer Protection Council. He contends that the baby may have
lived if his wife had been taken up for surgery earlier. (Total: 20 Marks)
A. Define the terms ‘Complaint’ and ‘Complainant’. What is the complaint and who is the
complainant in the above case scenario? (5 Marks)
B. Describe the Consumer Protection Redressal machinery. Up to how much compensation

can a District Consumer Protection Council give Mr. Somnath? If Mr. Somnath is not
happy with the verdict in the District Consumer Protection Council, where can he appeal
against it next? (5 Marks)
C. Who is a ‘Consumer’? What are the ‘Rights’ of a consumer? (3 Marks)
D. Discuss the general ‘duties’ and ‘responsibilities’ of a Physician as per Medical Council
of India (MCI) regulations: (7 Marks)
2. You are a Private Practitioner who has just completed the distance course in Family
Medicine. You have also sponsored a nurse to be trained as your Family Physician Assistant
and now you are setting up a Family Practice. One of the key concepts you want to put into
your practice is ‘Team Care’. (Total: 20 Marks)
A. Explain the benefits of Team Care: (5 Marks)
B. What are the things that a Family Physician Assistant can alone do in your Family
Practice before and after consultation? (8 Marks)
C. What are the things that a Family Physician Assistant can do along with the Physician
in your Family Practice? (7 Marks)
PART – B
1. THEME: TRAVEL MEDICINE - VACCINATIONS& PROPHYLAXIS [QUESTIONS. 1(i)

- 1(vi) (Total:6 Marks)
Options: B. Malaria Prophylaxis

C. Meningococcal Vaccination
A. Yellow Fever Vaccination D. Hepatitis Vaccination
E. Japanese Encephalitis G. Plague Vaccination
Vaccination H. Cholera Vaccination
F. Typhoid Vaccination
Questions:
1. (i). Mr. Rajnath is a business executive and you are the Family Physician for him and his
family for many years. He will be shortly travelling for a South American project of his
company, mostly in Colombia and Venezuela. What specific vaccination would you advice
for him?
1. (ii). Mr. Afzal, one of your patients, is planning to take a Haj Pilgrimage to Saudi Arabia.
What specific vaccination would you advice?
1. (iii). Mrs. Sunitha is working with the UNICEF in a South East Asian project and has to
visit some rural parts of Indonesia for that in the recent future, where she will be working in a
hospital. What immunization will be helpful for her to have?
1. (iv). Mr. Naik, one of your friends who is a Non Resident Indian (NRI) is planning to visit
his ancestral home in Odisha in North India. He calls you to find out about precautions and
immunisations. What is the most important one you would advise?
1. (v). A non-compulsory vaccination prevents a serious flavivirus infection but which is not
licensed in the US and Australia is
1. (vi) Col. Dr. Nitin is posted in Vietnam in a rural army outpost. What vaccine would you
suggest that he takes before going there?
2. THEME – CHARACTERISTICS OF A GOOD LEADER [QUESTIONS. 2(i) – 2(vi)]

(Total:6 Marks)
From the options ‘A to H’ given below, choose the best answer for the questions 2(i) –
2(vi)
Options:
A. Courage E. Character
B. Listening F. Commitment
C. Self discipline G. Good communication
D. Relationship H. Generosity
Questions: Which aspect of good leadership quality of a Family physician do the
following cases portray?
2 (i) Dr. Sudhan is regular in his daily exercise, has a balanced diet and spends daily ½ an
hour in professional updating. He is always punctual to the hospital.
2 (ii) Dr. Rajan has a special time called ‘Coffee Corner’ for his staff once a week, during
which time, he takes his staff by turns and spends half an hour with each staff over coffee.
2 (iii) When the Family Practice went through a bad patch financially, Dr. Sudakar kept
everyone on the team updated by having regular meetings and reassured them. As a result of
this the team stood with him till the crisis was over.
2 (iv) Dr. Kumar refused to write a fake medical certificate for a local Politician despite being
ordered by his boss to comply to the request.
2 (v) A poor labourer was rushed into Dr. Kumar’s clinic with a lower limb injury following
a road traffic accident. He had a closed fracture of the femur and was in shock. The wife had
no money in her hand. Dr. Kumar stabilized him hemodynamically and arranged for an
ambulance to shift him to a higher centre. He also gave Rs.500 to the wife to spend for the
treatment.
2 (vi) Dr. Latha planned her vacation in advance. She completed all her patient obligations,
informed her patients ahead of time about her absence and also arranged for a stop-gap doctor
to cover till she was back.
3. THEME: MALARIA PROPHYLAXIS[QUESTIONS. 3(i) – 3(vi)] (Total: 6 Marks)
From the options ‘A to J’ given below, choose the best answer for the questions 3(i) –
3(vi):
Options:
A. Cap Doxycycline 200 mg each day, 2 days before, during, 4 weeks after
B. Tab. Mefloquine 500 mg same day each week
C. Tab. Chloroquine 300 mg base same day each week 1 wk before, during, 4 wk after
D. Cap Doxycycline100 mg same day each week, 1 wk before, during, 4 weeks after
E. Tab. Chloroquine 600 mg base same day each week 1 wk before, during, 4 wk after
F. Tab Proguanil 100 mg (1 tab) same day each week 1 day before, during, 4 weeks after
G. Tab. Chloroquine 150 mg base same day each week 1 wk before, during, 4 wk after
H. Tab Proguanil 200 mg (2 tabs) same day each week 1 day before, during, 4 weeks after
I. Tab. Mefloquine 750mg same day each week
J. Tab Proguanil 50 mg (½tabs) same day each week 1 day before, during, 4 weeks after
Questions:
3 (i). Mr. Manoj is going for an official assignment to Bihar and you want to start Chloroquine
prophylaxis for him. Which regime will you follow?
3 (ii). Mina is going to a malaria-prone area for her work for 5 weeks and you know that it is a
Chloroquine resistant area. What will be your alternative drug and its dose?
3 (iii). Mina is also taking her 3 year old son with her to that chloroquine resistant malaria-prone
area. What will be your drug of choice and its dose?
3 (iv). Monisha went to a malaria-prone area and he was given malaria prophylaxis, but that drug
caused photosensitivity reaction. What drug can it be?
3 (v). 32 year old Subash, a business executive is attending a 1-week conference in Brazil which
also involves some field trips. What will be your drug of choice and its dose?
3 (vi) Which of the above drugs can be used only on a person who has a body weight of above 45
kg?
4. THEME: ROLES & RESPONSIBILITIES OF A FAMILY PHYSICIAN[QUESTIONS. 4(i) –

4(vi)] (Total:6 Marks)
From the options ‘A to J ’given below, choose the best answer for the questions 4(i )–4(vi)]:
Options:
A. Medical Expert F. Scholar

B. Communicator G. Professional
C. Collaborator H. Role Model
D. Manager I. Friend & Guide
E. Health Advocate J. Philosopher
Questions: What roles and responsibilities do the following Family Physicians fulfill ?
4 (i). Dr. Suman, a Family Physician is very keen on primordial prevention. He prescribes a
strict exercise regimen for his patients. He also displays posters about this all over his
practice and the neighbourhood. Every morning you can see him jogging along the seashore
regularly, without fail.
4 (ii). When Praveen was finishing his 12th grade, his Family doctor, Dr. Prasad, called him
and briefed him on all the career choices in the medical field.
4 (iii). Dr. Sam motivated all the people in his locality to give a request to the collector to
deal with the open sewage system in their locality which was causing a lot of health problems
to the residents.
4 (iv). Dr. Monisha’s patients are greatly benefitted as she closely works with and uses the
expertise of nurses, allied health professionals as well as specialists and super-specialists to
give quality patient care.
4 (v). Dr. Subash, is in charge of a Primary Health Centre (PHC). He wisely allocates the
budget on a fair basis to meet the various needs of the PHC, the staff and the patients.
4 (vi) When a sick patient died, the relatives started shouting and behaving badly. But when
Dr. Kaur explained and talked to them, they calmed down and went away
.
5. THEME: COMMON SPORTING INJURIES [QUESTIONS. 5(i) – 5(vi)] (Total: 6 Marks)
From the options ‘A to N’ given below, choose the best answer for the questions 5(i)–
5(vi):
Options :
A. Retinal tears H. Lateral Epicondylitis

B. Lens dislocations I. Olecranon dislocation
C. Medial epicondylitis J. Tenpin Bowlers Thumb
D. Game keepers thumb K. Corked Thigh (hematoma)
E. Haemorrhage into the various L. Hamstring injury
chambers
M. Achilles Tendon rupture
F. Corneal abrasion
N. Fracture of toes
G. Mallet Finger
Questions:
5 (i). Mr. Surjit Singh is a boxer and he sustained en eye injury in the last match. What is the
commonest injury to the eye in body contact sports?
5 (ii). Mr. Suresh is a national level Tennis player and he recently developed elbow pain. You
diagnose him to have ‘Backhand Tennis Elbow’. What condition gives rise to this?
5 (iii). Mr. Raman who lives in Manali, goes for skiing everyday. He sustained an injury to
his thumb. What is the commonest thumb injury that can happen in skiing?
5 (iv). Shylaa is part of the Women’s Cricket team and as she was trying to take a catch the
ball hit the tip of her finger resulting in hyperflexion of the finger. What can result from such
an injury?
5 (v). Mayank is an athlete developed soreness in his thigh which became better with RICE
treatment and graded stretching exercises. What is the injury he is likely to have sustained?
5 (vi). Positive Thompson’s test is diagnostic of this injury:

6. THEME – CHRONIC DISEASE MANAGEMENT [QUESTIONS. 6(i) – 6(vi)]
(Total: 6 Marks)
From the options ‘A to G’ given below, choose the best answer for the questions 6(i) –
6(vi)
Options:
A. Ensuring compliance E. Screening and Early detection

B. Looking for complications F. Patient and Carer education
C. Coordinating care with G. Wholistic Management of the
specialists Chronic Illness
D. Promoting self-capacity of
patient
Questions: Which aspect of chronic disease management are the following doctors
focusing on?
6 (i). Dr. Vinay is a Family Physician who has made a protocol in his Family practice that in
any patient over the age of 35, blood pressure should be checked. This is in line with the first
step in chronic disease follow up which is:
6 (ii). Dr. Sinhasends electronic reminders to all his diabetic patients to come for their
scheduled appointments. Which aspect of chronic disease management he is focusing on?
6 (iii). Dr. Manav Dassends a nurse for home-visits to all the postpartum mothers under his
care and they fill in a checklist which prompts them to look for bleeding per-vaginum,
postpartum fever etc. This is an example of this component of chronic disease management:
6 (iv). Dr. Dolly takes care of many patients with Asthma. She has employed a nurse
educator to teach use of Peak Flow Meter to some of the asthmatics to monitor themselves
and to change medication doses accordingly. Which aspect of chronic disease follow-up she
is focusing on?
6 (v). Dr. Susanorders Serum Creatinine and microalbuminuria tests for all her diabetic
patients annually. Which aspect of chronic disease follow-up she is focusing on?
6(vi). Dr. Scindia has two nurse educators in his out-patient department to have focus group
discussions for patients with diabetes and their relatives. Which aspect of chronic disease
follow-up he is focusing on?
7.THEME – TEN LEVELS OF CARE[QUESTIONS. 7(i) – 7(vi)] (Total: 6 Marks)
From the options ‘A to J’ given below, choose the best answer for the questions 7(i) – 7(vi)
Options:
A. Prevention C. Early diagnosis
B. Screening D. Diagnosis of established disease

E. Management of disease H. Terminal care
F. Management of complications I. Counseling
G. Rehabilitation J. Family Care

Questions: Which level of care is demonstrated in the following cases?
7 (i). Mr. Manikam had come with complaints of palpitations to you. You take a good history
and do complete clinical examination and diagnose it to be anxiety and stress-related. You
encourage him to talk to you about his home and work-related problems.
7 (ii). Mrs. Shantais a diabetic and is taking medicines from different doctors irregularly. She
is lately on homeopathy drugs and her sugars are not controlled. She has come to you for the
first time. You examine her, order relevant investigations, prescribe the necessary medicines
and make a follow-up plan for her.
7 (iii). Mrs. Malini, a 64 year old retired teacher has come to you with white discharge PV
since 2 months. She has been shy to reveal this and you convince her that you need to do a
pelvic examination to which she finally consents. On examination, you find that she has
Cervical Carcinoma Stage 3.
7 (iv). You teach Ms. Radha how to change the urinary catheter and care for her mother who
has a terminalmalignancy.
7 (v). Mrs. Malathi brings her 5 month old baby with history of cough and fever for 2 days.
On examination, you find that the baby’s pulse rate- 110/min, and respiratory rate is 46/min.
Onauscultation, the lungs were clear. You suspect that she has pneumonia and start her on
antibiotics. She sends a message after 2 days that the baby is well.
7 (vi). Mr. Puia is diagnosed with TB and is on ATT. You ask him to bring his 3 year old
granddaughter who lives in the same house to look for TB
8. THEME: GOVERNMENT PROGRAMS [QUESTIONS. 8(i) – 8(vi)] (Total: 6 Marks)

8(vi)]
Options:

B. Dengue and Chikungunya control Scheme (ICDS)
program H. Revised National TB Control
C. National AIDS control program Program(RNTCP)
D. Malaria control program I.National Filaria Control Program
E. Special Nutrition Program J.Kishori ShakthiYojana (KSY)
F. Mid-day meal program K.JSY (Janani Suraksha Yojana)
L. RSBY (RashtriyaSwastyaBimaYojana)
part of:
8 (i). Transmission control with mass administration of drugs and disability prevention for
those who already have the disease by offering home-based as well as hospital-based
management as warranted are components of this national program:
8 (ii). Eight Key elements (Octalogues) of Mid Term Plan of this program are:(i) Disease and
Vector Surveillance, (ii) Case management, (iii) Laboratory diagnosis, (iv) Vector
management, (v) Outbreak response, (vi) Capacity building, (vii) Behaviour Change
Communication, (viii) Inter-sectoral coordination and (ix) Monitoring & Supervision
8 (iii). This program is an Indian government-sponsored conditional cash transfer scheme to

reduce the numbers of maternal and neonatal deaths and increase health facility deliveries in
BPL families.
8 (iv). Supplementary feeding of about 300 calories and 10 grams of protein to preschool
children and about 500 calories and 25 grams of protein to pregnant and breastfeeding
8 (v). Indoor insecticide spray in endemic areas is done in this program:
8 (vi). Indoor insecticide spray during epidemic months of June/July is done in this program:
9. THEME – CHARACTERISTICS OF A FAMILY PHYSICIAN [QUESTIONS. 9(i) – 9(vi)]

(Total: 6 Marks)
From the options ‘A to H’ given below, choose the best answer for the questions 9(i) –
9(vi)
Options:
A. High level of Diagnostic and E. A command of complexity and

therapeutic skill uncertainty
B. Offers Family centered care F. Provides Whole person care
C. Disease centeredness G. Provides Coordinated care
D. Offers Continuity of care H. Comprehensiveness
Questions: Which aspect of Family Medicine do the following cases portray?:

9 (i). When Mrs. Fatima came with multiple somatic complaints and her Family Physician
gently elicited the fact that she was depressed and found the cause of worry to be her son who is
an alcoholic. The Family Physician counseled her and invited her to bring her son with her next
visit.
9 (ii). Mr. Suman is brought to you with chest pain. You do an ECG and you find that he has
Acute Coronary Syndrome (ACS). You call up a known cardiologist, arrange an ambulance and
refer him with a well-drafted referral letter.
9 (iii). Mr. Yadav is an asthmatic who takes irregular medicines usually obtained over-the-
counter. He has come to you with one of his frequent exacerbations. After settling the acute
problem, you discuss with him and chalk out a follow-up plan for him.
9 (iv). Mr. Pal is newly diagnosed with TB and you started Anti- Tuberculosis Therapy. You
also screen him for diabetes and HIV. You teach him how to discard sputum and how to
maintain good healthy diet. You advise him on work-related issues. You also ask him to bring
his 3 year old granddaughter who lives in the same house for screening for TB.
9 (v). You work in a rural clinic in a tribal belt in South India. Mrs. Mousamibrings her 4 year
old son with headache and fever for 2 days. You find on examination that he is febrile, his radial
pulse rate- 100/min and respiratory rate is 28/min. He had neck stiffness but all other systemic
examinations were normal. You start treatment for meningitis and she brings him to you well in
2 days’ time.
9 (vi). You arrange for a periodic ophthalmologist visit to your clinic to get your diabetic
patients who are due for an ophthalmoscopy checked for diabetic retinopathy.
10. THEME – COMMUNITY ORIENTED FAMILY PRACTICE [(QUESTIONS. 10(i) – 10(vi)]

(Total:6 Marks)
10(vi)
Options:
A. True
B. False
Questions:
10 (i). Clinicians think normally in terms of single patients rather than population groups.
Family physicians have to think in terms of both.
10 (ii). Ideally, the family physician should share the same habitat as his patients.
10 (iii). Communication with the patient and other team members, Participation, as needed, in
home care/family conferences, Evaluation of quality of care are all components of the
Community Oriented Primary Care (COPC)
10 (iv). A home visit can be either diagnostic or therapeutic, and is often a combination of
both.
10 (v). In COPC, home care and house calls are 2 separate entities.
10 (vi). Feasibility of intervention and Commonness of a problem are important criteria for
prioritization in a COPC.
***********
(LG 0215) M.MED.FAMILY MEDICINE (Sub Code: 4014)
SECOND YEAR THEORY EXAM– FEBRUARY 2015
QP .CODE: 434014
Time: Three hours Maximum Marks: 100
INSTRUCTIONS

• Part B will have Objective type EMQs Extended Matching Questions (60 marks).
C, D and so on.
Example:
3. THEME –COMMON PSYCHIATRIC PROBLEMS [QUESTIONS. 3(i) – 3(vi)] (6Marks)
Options:
A. Inj. Haloperidol
E. Tab. Diazepam
F. Tab. Lithium
H. Tab. Risperidone
3(ii) F
3(iii)
3(iv)
3(v)
9 Each option may be used more than once. 3(vi)
Some options may not be used at all.
1
PART – A
1. You have a primary health care setup in a village. You take care of 6 villages with a total
population of 8000. Around 50% of the patients in your clinic need chronic disease care.
(Total: 20 Marks)
A. What are the components of Chronic Disease Management in Primary care? (5 Marks)
B. What are the steps in management of chronic disease? (5 Marks)
C. How do you ensure compliance of a patient with chronic disease? (5 Marks)
D. How can we promote the individual’s capacity to manage the disease? (5 Marks)
2. You are a Medical Officer in a Government PHC. Apart from your clinical and other
administrative responsibilities, you supervise implementation of many National health
programs. Answer the following questions on some of the National health programs.
(Total: 20 Marks)
A. What are the programs available for communicable (infectious) diseases? (5 Marks)
B. What are the programs available for improving the nutrition of mothers and children?
(5 Marks)
C. Name and describe the program that is targeted towards adolescent girls? (5 Marks)
i. Who are the beneficiaries
ii. What are the benefits of this program?
iii. What are the common services offered?
iv. What are the Eligibility Criteria?
v. Explain briefly how to avail the benefits?
D. Explain about one program that is targeted towards antenatal women. (5 Marks)
i. Who are the beneficiaries
ii. What are the benefits of this program?
iii. What are the common services offered?
iv. What are the Eligibility Criteria?
v. Explain briefly how to avail the benefits?
PART – B
1. THEME – MEDICAL ETHICS [(QUESTIONS. 1(i) – 1(vi)] (Total: 6 Marks)

From the options ‘A’ to ‘F’ given below, choose the best answer for the questions 1(i)–1(vi)
Options:
A. Beneficence D. Justice
B. Non maleficence E. Paternalism
C. Autonomy F. Autocracy
2
Questions:
1(i). Mr. Raj has come with symptoms of dysuria and fever. After making a diagnosis of
uncomplicated UTI, though Mr. Raj could be treated with antibiotics the physician admits him
for IV antibiotics because there were few inpatients in his private nursing home. What principle
of bioethics is breeched here?
1(ii). When Mr. Murugan had a left sided subdural hemorrhage which needed surgical
evacuation, his cranium was opened on the right side by the neurosurgeon. What principle of
bioethics is not taken care of here?
1(iii). When Mr. Mani had colonic cancer and advised resection and colostomy, he refused. His
doctor explained about the outcomes and discussed about the alternate modes of treatment.
What ethical principle comes into play here?
35 year old Mrs. Valliamma was diagnosed with carcinoma cervix stage1. The surgeon did a
hysterectomy and bilateral salpingo oophorectomy but Mrs. Valliamma was not explained
that her uterus and ovaries are being removed. “What will she understand? I have done what
is good for her” is the statement of the surgeon.
1(iv). What is this attitude called in medical ethics?

1(v). What is the principle of bio ethics which is not followed in Mrs. Valliamma’s case?
1(vi). In a pediatric outpatient clinic, when children are waiting with medical conditions
requiring immediate attention, a local VIP walks in and demands to see the doctor immediately
because his 3 year old daughter has a dark patch on her cheek from birth. What ethical principle
should come into play here, while you handle this situation?
2. THEME – CHARACTERISTICS OF A FAMILY PHYSICIAN [QUESTIONS. 2(i) –

2(vi)] (Total: 6 Marks)
Options:
B. Comprehensiveness uncertainty
C. Disease centeredness F. High level of Diagnostic and therapeutic
D. Continuity of care skill
G. Coordinated care
Questions: What characteristics do the following Family Physicians portray in each of the
scenarios described below?
2(i) 7 year old Geetha presented with high grade fever with right knee swelling and pain for
1day. Dr. Rajesh suspected that she has septic arthritis and did a knee aspiration and sent it to lab
and confirmed the diagnosis. He started her on appropriate antibiotics because the family could
not afford referral and the child is better now.
3
2(ii) Mr. Gopal has come to Dr. Hari with complaints of giddiness and his BP was found to be
high in repeated occasions. Dr. Hari explains to him about the disease and starts on medications.
He has also asked him to come back after 15 days for review.
2(iii) 2 year old Felci was brought to Dr. Mala because her mother was worried that she is not
like other kids. Dr. Mala did developmental screening and found her milestones were delayed
and then referred her to a developmental pediatrician.
2(iv) Mrs. Sharada presented to you with aches and pains for the past 6 months. On questioning
her you found that her main problem is her husband who is an alcoholic and gives her lot of
trouble. You decided to call her and her husband along with her mother in law who lives with
them to have a family conference.
2(v) You always assign every second Thursday afternoon for retinopathy screen of your diabetic
patients and arrange an ophthalmologist to come to your clinic and see them.
2(vi) Mr. Ganesh has been diagnosed to have Lung cancer. Dr. Balakumar, the pulmonologist is
worried about all the complications he may develop and advises expensive treatments, but the
family is finding it impossible to comply as they are struggling to make ends meet.
3. THEME: TYPES OF REFERRALS [QUESTIONS. 3(i) - 3(vi) (Total: 6 Marks)

Options :
Questions: What is the type of referral which is described in the following scenarios?
3(i). Mr. Sudhesh has come to you with complaints of abdominal pain for the past one hour.
This is his first visit to you and you refer him to a surgeon for Appendectomy. After surgery, he
goes back to his native place for recuperation.
3(ii). Mr. Ezhil, whom you are treating for diabetes, has developed retinopathy and you refer him
to an ophthalmologist for Laser therapy. While he is treating the retinopathy, you continue to
take care of his diabetes.
3(iii). You find that Mrs. Priyanka, who is being taken care of by you in your antenatal clinic,
has a valvular heart problem and you refer her to a cardiologist for opinion and treatment. After
surgery, since she is a high risk pregnancy, she is referred to an obstetrician.
3(iv). Mr. Rajesh is your regular patient, and this time he has come with a compound fracture of
his forearm. You refer him to an Orthopedician for an open reduction. After the procedure and
the recovery period is over, he comes to you for regular consultations.
4
3(v). Ms. Leela, an IT engineer, has complaints of headache for the past 2 months after she has
transferred to a new office. When she visits a doctor, she is referred to an ophthalmologist,
Neurophysician, ENT specialist and a Psychologist for checkup.
3(vi). Mrs. Sudha is your regular patient for many years. Now she is 35 years and she has
become pregnant for the first time after 12 years of marriage. Her height is 134 cm and you refer
her to a Gynecologist for further care and safe delivery.
4. THEME: TRAVEL MEDICINE [QUESTIONS. 4(i) - 4(vi) (Total: 6 Marks)

From the options ‘A to F’ given below, choose the best answer for the questions 4(i)–4(vi).
Options :
A. Mebendazole or Albendazole
B. Praziquantel
C. Albendazole or thiabendazole
D. Symptomatic treatment
E. Ceftriaxone and metronidazole
F. Doxycycline
Questions: What is the management of the following patients with illnesses acquired during
travel?
4(i). Treatment for 26 year old Mr. Gopal with Scrub typhus
4(ii). Treatment for 32 year old Mr. Kavin with Schistosomiasis. He has recently returned from
Egypt.
4(iii). Treatment for 6 year old Suraya with Trichuriasis
4(iv). Treatment for 12 year old Sameer with Hookworm infestation
4(v). Treatment for 41 year old Mr. Das with Cutaneous larva migrans
4(vi). Treatment for 4 year old Junaya with Dengue fever
5. THEME–CHRONIC DISEASE FOLLOWUP [QUESTIONS. 5(i)–5(vi)] (Total: 6 Marks)

Options:
A. Screening and Early detection
B. Ensuring compliance
C. Looking for complications
D. Coordinating care with specialists
E. Promoting self-capacity of patient
F. Patient and career education
5
Questions:
5(i) You are planning for an organized Chronic disease care in your clinic. What is the first step
in chronic disease follow up?
5(ii) Dr. Raj uses an Electronic recall systems like PCICS to follow his diabetic patients. Which
5(iii) Dr. Das sends Mr. S with a diabetic foot with ulcer for debridement to a surgeon. Which
5(iv) Dr. Dutta has a medical assistant in his team who will take care many aspects including
teaching self-assessment of peak flow of all his asthmatic patients. Which aspect of chronic
disease follow-up he is focusing on?
5(v) Dr. Moorthy does monofilament testing for his diabetic patients on a routine basis. Which
5(vi) Dr. Manjukar has a volunteer team in OPD to have focus group discussions for patients
6. THEME – CONSULTATION [QUESTIONS. 6(i) – 6(vi)] (Total: 6 Marks)

Options:
A. Responsibility sharing
B. Checking concerns
C. Checking ideas
D. Checking expectations
E. Risk reduction
F. Setting goals
Questions: Which aspect of consultation is being dealt with in the following dialogues?
6(i) Dr Shanta, a Family Physician asked her patient who was a teeneage girl with acne, ‘Tell me
about what you think is causing it.’
6(ii) Mr Somu went to his Family Physician as he was worried about his headache and his
Family Physician asked him in the middle of the consultation, ‘What was the worst thing you
were thinking it might be?’
6(iii) Dr Lata asked Mrs. Ganesh, ‘How might I best help you with this?’
6(iv) Dr. Prakash told Mr Jani, ‘You have to monitor your asthma control twice a day. You can
call me in this number if you have any difficulty’.
6
6(v ) Dr. Sailo asked his patient, “So… shall we say, weight reduction of 1 kg a month?”
6(vi) Dr. Gurdeep asked his patient “How many cigarettes a day are you smoking now?”
7. THEME – CHARACTERISTICS OF A GOOD LEADER [QUESTIONS. 7(i) – 7 (vi)]

(Total: 6 Marks)
From the options ‘A to I’ given below, choose the best answer for the questions 7 (i) – 7(vi)
Options:
A. Character F. Listening
B. Commitment G. Self discipline
C. Good communication H. Relationship
D. Courage I. Organizing
E. Generosity
Questions: Which aspect of good leadership quality of a Family physician do the following
scenarios portray?
7(i) When there is a team meeting, Dr. Lal gives the introduction and then lets the team members
talk about the issues where he observes and give just inputs occasionally.
7(ii) Dr. Mathew plans his day ahead and as far as possible adhere to it. The hospital staff who
works with him finds it easy to cooperate.
7(iii) When the primary care team arranged a health camp, Dr. Kailash called all his staff and
explained to them all what needed to be done and how they were going to do that.
7(iv) Mr. Kumar, does not take commission from the local labs for referring the patients for
investigations unnecessarily even though he came to know the chain of labs in the town were
owned by a local politician and he was threatened indirectly.
7(v) When 5 months old Kalai needed a referral for her severe pneumonia, Dr. Kumar paid for
the ambulance and transferred the child to a secondary care hospital 40 km away, spoke to the
hospital to send the bill to him and gave some money to the mother for the expense on the way.
He did this because he knew the family’s financial situation.
7(vi) Dr. Sudha’s team worker’s feels comfortable working with her because they feel they can
contact her any time to clarify their doubts.
8. THEME-HOME VISIT [QUESTIONS. 8(i) – 8 (vi)] (Total: 6 Marks)

One option can be used more than once.
Options:
A. Community based care
B. Home based care
7
C. Home care
E. Diagnostic home visit
F. Family conference
G. Family therapy
Questions: Which type of care is portrayed in the following examples?
8(i) Mr. Rajan who has developed a stroke is being taken care of by his wife and children, after
being taught by the primary care worker sent to his home by his Family Physician Dr. Khandekar.
8(ii) Mr. Neil, a physician’s assistant visits Mr. Rajan to change his catheter every month.
8(iii) Dr. Balan was called to see Mr. Gopal who was breathless. He examines him and finds
Mr. Gopal has acute exacerbation of asthma.
8(iv) Dr. Ranjan visits the house of Heera, a teenager, who has depression and had expressed
ideas of self-harm.
8(v) Dr. Saleem visits the family of Mr. Lal, who as pancreatic carcinoma for adjustment of
medications for his palliative care every month. Mr. Lal finds it very comforting than visiting a
hospital.
8(vi) Dr. Senthil visits Mrs. Jansi, a 75 year old hypertensive who lives alone to check her BP
and medications.
9. THEME: GOVERNMENT PROGRAMS [QUESTIONS.9(i)-9(vi)] (Total: 6 Marks)

From the options ‘A to L’ given below, choose the best answer for the questions 9(i)–9(vi)
Options:
A. Kala Azar control program H. Revised National TB Control Program
B. Dengue and Chikungunya control (RNTCP)
program I. Reproductive and Child Health Program
C. National AIDS control program (RCH)
D. Malaria control program J. Kishori ShakthiYojana (KSY)
E. Special Nutrition Program K. JSY (Janani Suraksha Yojana)
G. Integrated Child Development Services
Scheme
Questions: Identify to which Government program, each of the following components is

part of:
9(i). Dr. Fatima is able to convince her patients to opt for Institutional delivery because of this
program.
9(ii). Dr.Vijula, who works in a malaria endemic area, operates Vector control through IRS
with DDT up to 6 feet height from the ground twice annually through this program.
8
9(iii). Dr. Keerthana is able to do Prevention of Parent to child transmission of disease through
this program.
9(iv). Dr. Heera, when posted in her PHC found lots of children with PEM. Now she is able to
arrange Supplementary feeding of about 300 calories and 10 grams of protein to preschool
children and about 500 calories and 25 grams of protein to pregnant and breast feeding mothers
for six days a week through this program.
9(v). Dr. Isaac, who works in a Kalaazar endemic area, operates Indoor insecticide spray in
endemic areas through this program.
9(vi). Dr. John who works in Kerala, makes use of this program for Indoor insecticide spray
during epidemic months of June/July.
10. THEME – SPORTS INJURIES [(QUESTIONS. 10 (i) – 10(vi)] (Total: 6 Marks)

From the options ‘A to J’ given below, choose the best answer for the questions 10(i)–10(vi)
Options:
A. Injury to rectus femoris F. Achilles tendinitis
B. Iliopsoas bursitis G. Complete rupture of Achilles tendon
C. Tinea cruris H. Partial rupture of Achilles tendon
D. Tibial stress fracture I. Plantar fasciitis
E. Tibialis anterior tenosynovitis J. Osteitis pubis
Questions: Choose from the options above, the right diagnosis for the following patients:
10(i) . Mr. Louis, a sportsman presents with pain in left groin for the past 2 months. Radiation of
pain is to the adductor muscles of both thighs; pain aggravated by exercise, especially twisting
and turning and kicking. On examination, he has a mild waddling gait; and there is local
‘pinpoint’ tenderness to palpation over the symphysis.
10 (ii). Mr. Krishnan has come with acute onset of groin pain from yesterday evening after
playing football.
10 (iii). Mr. Jeyanth has come with pain and localized tenderness over the distal posteromedial
border of the tibia which is noted after running and usually relieved by rest.
10 (iv). Mr. Hari had an ankle injury when rushing down the stairs yesterday. A sudden sharp
pain was noticed at the time of injury; and now complains of sharp pain in the site of
tendoachilles area when stepping off affected leg.
10 (v). Mrs. Kanitha had an ankle injury when rushing down the stairs yesterday. Sudden onset
of intense pain was noticed at the time of injury; she fell over. Now there is swelling and
bruising in the site of tendoachilles area; and there is some difficulty walking, especially on
tiptoe.
10 (vi). Mrs. Devi has pain in the tendoachilles area. Tendon feels stiff, especially on rising;
tender thickened tendon; there is palpable crepitus on movement of tendon.
********
9
M.MED.FAMILY MEDICINE
SECOND YEAR THEORY EXAM– AUGUST 2015
PAPER IV -FAMILY MEDICINE AND PRIMARY CARE
Q.P. Code: 434014
TIME: THREE HOURS MAXIMUM: 100 MARKS
INSTRUCTIONS

• The Paper has 2 parts – Part A& Part B.
• Part A will be descriptive typequestionsbased on case scenarios (40 marks).
• Part B will have Objective type EMQsExtended Matching Questions&
MCQs(Multiple Choice Questions)(60 marks).
9 For EMQs, each set has a theme on the top. In each set there are some options given on
the top followed by some questions. The options are lettered using the English Alphabets
A, B, C, D and so on.
Example:
Options:
A. Inj. Haloperidol
E. Tab. Diazepam
F. Tab. Lithium
G. Inj. Fluphenazinedeconoate
H. Tab. Risperidone
1
PART – A
1. You are called to give a lecture on National health programs to a class of nursing
students in a nearby Nursing school. Answer the following questions related to that:
(TOTAL: 20 MARKS)
A. How the National health programs are broadly classified? Give 2 examples for each.
(4Marks)
B. Write the benefits, beneficiaries and where people can utilize the Integrated Child
Development scheme.(ICDS) (4Marks )
C. Write thebenefits, beneficiaries and where people can utilize the Mid-day meal program.
(4 Marks)
D. Write a short note on Janani Balsuraksha Yojana, highlighting the aim, beneficiaries of
the program and how it is delivered (4 Marks )
E. Write a short note on National Program for control of Blindness, highlighting the aim,
beneficiaries of the program and how it is delivered (4 Marks)
2. Your MBBS classmate has come to know that you have Chronic Disease Follow Up in
your clinic which has improved your practice. He has come to see you. Answer the
following questions related to ChronicDisease Follow up. (TOTAL: 20 Marks)
A. Name 4 advantages of Chronic Disease Follow up. (4Marks )

B. Name 8 diseases where Chronic Disease Follow up must be done. (4 Marks )
C. A Chronic Disease Follow Up team must have at least 3 persons with different roles.
i. Whoare these 3 persons?
ii. What are all the “principles of working together as a team” in a Chronic Disease
Follow up? (4 Marks)
D. Name minimum 8 things you will screen in a patient with Diabetes attending your
Chronic Disease Follow up OPD (4Marks)
E. What are all the components of Chronic Disease management in primary care?
(4 Marks)
2
PART – B
1. THEME:ROLES OF A FAMILY PHYSICIAN[(QUESTIONS. 1(i) – 1(vi)]

(TOTAL: 6 MARKS)
From the options ‘A’ to ‘F’ given below, choose the best answer for the questions 1(i) –
1(vi)
Options:
A. Health advocate D. Medical expert
B. Role model E. Scholar and teacher
C. Communicator F. Collaborator
Questions:
1 (i). 10 months old Vanitha is brought with vomiting, loose stools for 2 days. Dr. Ravindran
took a proper history, examined her and diagnosed her to have some dehydration and started
the plan B treatment with ORS. He also started her on T. cotrimoxazole since she had blood
in her stools. The role exhibited by Dr. Ravindran is
1 (ii). Mr. Sunder was under Dr. Robin’s care. He had oliguria for the past 4 hours which
Dr.Robin was correcting. He called Mr. Sunder’s son and explained the situation clearly and
informed him that if he is not putting out enough urine in the next few hours, Mr. Sunder
may have to be shifted to a higher Centre where there is dialysis facility.The role exhibited
by Dr. Robin is
1 (iii). Four hours later, there was not enough urine output. So Dr. Robin called the
Nephrologist at the higher Centre and explained and referred Mr. Sunder. He also told the
nurse to call the ambulance driver and shift him at the earliest. The role exhibited by Dr.
Robin is
1 (iv). When Dr. Lee saw many people from the local factory came with injuries from the
machinery, he went to the factory owner and asked him to install basic safety equipment.The
role exhibited by Dr. Lee is
1 (v). Dr. Yasmin used to take regular classes for the Nursing, Physiotherapy and
Occupational therapy students posted in her unit. The role exhibited by Dr. Yasmin is
1 (vi). Dr. Logeswari always tries to sit erect while sitting in the clinic. When asked she told
that then only she can advice her patients about back care. The role exhibited by Dr.
Logeswari is
3
2. THEME – RESPONSIBILITIES OF A FAMILY PHYSICIAN
From the options ‘A to F’ given below, choose the best answer for the questions 2 (i) – 2
(vi)
Options:
A. Maintaining good health D. Maintaining good medical practice

B. Providing Good clinical care E. Working with colleagues
F. Teaching and training
C. Exhibiting Honesty
Questions:What responsibilities ofthe Family Physicians are portrayed in each of the
2 (i). Mrs. Radha told Dr. Kumar that she has aches and pains. By taking a detailed history
and doing a thorough clinical examination, Dr. Kumar diagnosed her to have depression. He
took time to educate her and gave resources to read.
2(ii) Dr. Gopal keeps himself updated by gathering information from the journals,internet
resources like Pub-med etc….
2(iii) Dr. Xavier makes sure that the clinical meeting happens every week so that the nurses,
nursing students and the paramedical update their clinical learning.
2(iv). Dr. Somu communicates well with his cleaner, attender, lab technician and the nurses
so that the work is done smoothly.
2(v).The pharmaceutical representative requested Dr. Anbusudhan to prescribe the new drug
which is costlier to his patients and offered him a free trip to Singapore but he refused.
2(vi) Dr. Lakshmanan is 56 years old and he is not a diabetic or hypertensive. He wakes up at
5.30 AM and does regular physical exercise for 30 minutes. He avoids much sweets and junk
foods and includes a lot of fruits and vegetables in his diet.
3. THEME: BIO MEDICAL ETHICS [QUESTIONS. 3(i) - 3(vi) (TOTAL: 6 MARKS)

From the options ‘A to D’ given below, choose the best answer for the questions 3(i) –
3(vi)
Options:
A. Beneficence C. Autonomy
B. Non-maleficence D. Justice
4
Questions: What is the Bio medical ethical principle involved in each of the following
scenarios?
3. (i). Dr. Kannan, the PHC medical officer was attending Mr. Suresh, a victim of road traffic
accident. The local MLA brought his wife who had migraine and on seeing Suresh, the MLA
felt that he was not sick. He threatened that if Dr. Kannan did not attend his wife
immediately, he will report to the Deputy Director of health services. Dr. Kannan stabilised
Mr. Suresh and then only attended the MLA’s wife.
3. (ii). Mr. Babu was having chronic obstructive pulmonary disease with respiratory failure
and he was deteriorating. He requested Dr. Madan to discharge him so that he could die
peacefully at home. Dr. Madan honoured his request and 2 days later he peacefully died at
home.
3. (iii). Dr. Kamesh allotted a kidney from a brain dead patient to 25 year old Mr. Kumar with
renal failure though he was offered a huge sum by the relatives of 80 year old Mr. Nandhir
who had Diabetic nephropathy.
3. (iv). 12 year old Ganesh needed an appendicectomy. Dr. Uday knew that his parents may
not be able to pay his fees if operated in his private nursing home. So he arranged for the
surgery to be done free of cost.
3. (v). Mr. Shankar was posted for right hernioplasty. Dr. Ratnam by mistake has done left
hernioplasty. What ethical principle is violated here?
3.(vi). Dr. Kamala forced Mrs. Saroja to have cu-T inserted though Mrs. Saroja preferred oral
contraceptive pill than cu-T. What ethical principle is violated here?
4. THEME: MEDICAL ETHICS [QUESTIONS. 4(i) - 4(vi) (TOTAL: 6 MARKS)

From the options ‘A toS’ given below, choose the best answer for the questions 4 (i) – 4
(vi).
Options:
A. T. Voveran 50 mg tid K. Minimum 3 years
B. After the treatment L. 48 hours
C. Ethical M. Minimum 30 hours every 5 years
D. Before the treatment N. 72 hours
E. During the treatment O. Minimum 4 years
F. Can be prescribed P. At least 30 hours every 3 years
G. Minimum 5 years Q. Diclofenac sodium 50 mg tid
H. Unethical R. Diclofenac sodium 1 tablet tid
I. T. Diclofenac sodium 50 mg tid S. No fee for treatment
J. Minimum 60 hours every 5 years
5
Questions:
4. (i). According to the code of Medical ethics,to maintain a good medical practice, atime
duration a physician is expected to participate in professional meetingsas part of continuing
medical education is
4. (ii). According to the code of Medical ethics, how many years is a physician expected to
maintain the medical records pertaining to his/her indoor patients?
4. (iii). According to the code of Medical ethics, within what period of time is any request
made for medical records by the patient/authorized authority be duly acknowledged and
document be issued?
4. (iv). Mr. Ganesh has come with osteoarthritis of knees. Dr. Govindan is planning to give a
NSAID for him. The right way to write the prescription is
4. (v). According to the code of Medical ethics, the time to announce the physician’s fees to
the patient for rendering a service is
4. (vi). According to the code of Medical ethics, the time to announce the physician’s fees to
another physician for rendering him/her a service is
5. THEME:RESPONSIBILITIES OF CLINICAL ASSISTANT AND PHYSICIAN

From the options ‘A to C’ given below, choose the best answer for the questions 5(i) –
5(vi)
Options:
A. Assistant only
B. Assistant and physician
C. Physician only
Questions: For the responsibilities given below choose who among the answer given
above will be performing them.
5 (i) Takes history from patient

5(ii) Obtains verbally all the information already gathered
5(iii) Review of systems
5(iv) Updates the problem list
5(v) Usesthe pulse oximeter
5(vi) Performspertinent physical examination and communicate findings
6
6. THEME:FUNCTIONS OF A FAMILY PHYSICIAN [QUESTIONS. 6(i) – 6(vi)]
(TOTAL: 6 MARKS)
From the options ‘A to F’ given below, choose the best answer for the questions 6(i) –
6(vi)
Options:
A. Working with community D. Organising home visits
B. Involves in preventive care E. Empowering people for their own

health
C. Accountability
F. Competent clinician
Questions:Which function of the Family Physician is portrayed here?
6 (i) Dr. Sonu with the help of the social worker maintained the income and expenditure
incurred in running the health camp conducted in his village and presented it to the team.
6 (ii) Dr. Arasu has a meeting with all the ward members and the President of the village
once a month to know the felt need of the people and tries to fulfil their needs.
6 (iii) Dr. Naveen a PHC Medical officer has trained the adolescent boys and girls in the
locality to give health education and the women’s self-help group members to distribute
Vitamin A and albendazole to all the Under 5s in his care.
6 (iv) Dr. Prakash told his team to go and see Mr. Baskar at home who was suffering from
carcinoma bronchus.
6 (v) Dr. Chandan makes sure that the immunization coverage in his PHC is more than 95%
6 (vi) When Mr. Kadhir came with breathlessness Dr. David diagnosed him to have
Pneumothorax and immediately inserted a chest tube and reduced his breathlessness. After 7
days he was completely normal and the chest tube was removed and he went home happily.
7. THEME – HEALTH INFORMATICS[QUESTIONS. 7(i) – 7 (vi)]

(TOTAL: 6 MARKS)
From the options ‘A to H’ given below, choose the best answer for the questions 7 (i) –
7(vi)
Options:
A. Data entry D. Power back up
B. Training of staff E. Data retrieval
C. Data Security F. Data analysis
7
G. Data Reporting H. Data Collection
Questions:
7 (i) When you entered your office in the night you saw your ward boy sitting infront of the
computer. When you reached there without him noticing,you found that he was gathering
information about a patient about whom his friend wanted to know. Which aspect of clinical
information storage is weak here?
7 (ii) Dr.Mohan when he installed the new clinical information system he made sure that the
technical person teach all his people about how to use the various tools in the software and
told him to come once a month so that they can clear all their doubts with him.Which aspect
of clinical information storage is strong here?
7 (iii) Dr. Ramesh has made sure that the name,sex,date of birth,vaccination history, height,
weight, BMI and many other important variables of all the patients coming to his clinic is
captured into the system.Which aspect of clinical information storage is strong here?
7 (iv) The systems in Dr. Gupta’s clinic do not allow reception staff to access the clinical
records at all.Which aspect of clinical information storage is strong here?
7 (v) Dr. Nitin wanted to know how many patients registered in his clinic from a particular
area of the town are overweight/obese. He could get this data within 30 seconds. Which
aspect of clinical information storage is strong here?
7 (vi) Dr. Kandan has invested Rs. 2 lakhs on solar panelsfor uninterrupted power supply for
his clinic. Which aspect of clinical information storage is strong here?
8. THEME: HOME VISITS [(QUESTIONS. 8 (i) – 8(vi)] (TOTAL: 6 MARKS)
(vi)
Options:
A. Emergency illness home visit E. Hospitalisation follow up home
B. Chronic illness home visit visit
C. Grief support home visit F. Terminal care home visit
D. Assessment home visit
Questions: Identify the type of home visit in the scenarios given below:
8 (i). 14 year old Malathi was brought with bruises on her left forearm. Dr. Ganesh suspects
an abuse. He makes a home visit to Malathi’s home.
8 (ii). Mr. Gopi had a stroke and was admitted in the hospital 2 weeks ago. Last week he was
discharged. Dr. Randir with the health worker made a home visit to Mr. Gopi’s home.
8 (iii). Mrs. Shanthi is living 100 metres away from your clinic. This morning her saree
caught fire while she was cooking in the kitchen. Her neighbour came running to you to come
and save her. You are visiting Mrs. Shanthi’s home.
8
8 (iv). Mr. Rajan had carcinoma colon. He was under your care f or the past 2 years. Last
week he passed away. Today you and the health worker are making a home visit to his home.
8 (v). Mrs. Sita is an 80 year old grandma under your care. She has diabetes, hypertension
and she had a stroke 6 months ago and has recovered. You are making a home visit to her
home with your health worker.
8 (vi). Mrs. Vanaja had carcinoma lung with secondaries in the liver. She was deteriorating
and you were giving palliative care to her. You get a call from her husband saying that she
was gasping and you are visiting her home immediately.
9. THEME: FAMILY PHYSICIAN AND COMMUNITY [QUESTIONS. 9(i) – 9(vi)]

(TOTAL: 6 MARKS)
(vi)
Options:
C. Looking for complications F. Patient and care taker education
Questions:
9 (i). Dr. Pai uses a paper based register recall system for follow-up of his diabetic patients.
9 (ii).Dr. Dinakar sends a nurse for home-visits to all his patients with coronary artery
disease. Which aspect of chronic disease follow-up he is focusing on?
9 (iii).Dr. Dutta has employed a nurse educator to teach SMBG (Self-Monitoring of Blood
Glucose) to his diabetic patients. Which aspect of chronic disease follow-up he is focusing
on?
9 (iv).Dr. Nesan does monofilament testing for his diabetic patients on a routine basis. Which
9 (v).Dr. Manjukar has a volunteer team in OPD to have focus group discussions for patients
with diabetes and their relatives. Which aspect of chronic disease follow-up he is focusing
on?
9 (vi). Dr. Punitha, a Family Physician, uses an Electronic recall systems like PCICSto follow
her diabetic patients. Which aspect of chronic disease follow-up she is focusing on?
9
10. THEME: COPC – [QUESTIONS. 10(i) – 10 (vi)] (TOTAL: 6 MARKS)
Choose the single best option for the questions 10(i) – 10(vi).
10 i).Dr Madhukar works in Bihar. As a Family Physician, he understands how a
disease condition is serious by this indicator:
A. Admission rate
B. prevalence and incidence
C. Case fatality rate
D. The ratio of funds spent for the condition in relation to total expense
10 ii). Dr Sudhakar works with the NRHM in Jharkhand and has to be involved in a lot
of primary care initiatives. As a Family Physician, he understands how common a
condition is by this indicator:
A. Admission rate
10 iii).When Dr Milind, a Family Physician, views his practice as a "population at risk”,
he/she thinks in terms of
A. Single patient
B. Community
C. Disease profile
D. Both A and B
10 (iv).Dr Sadhna is committed to the practice of COPC. The Philosophy of COPC is
A. Individual is more important than the community
B. Care of community and care of an Individual are two separate entities
C. The care at the individual level takes care of the community
D. One would look to prevent a disease from occurring among high risk individuals
rather than only seeking to improve their treatment.
10 (v). The correct sequence of the steps in COPC is
A. Intervention strategies, definition of population, initiation of intervention, surveillance
and program evaluation
B. Intervention strategies, initiation of intervention, definition of population, initiation of
intervention, surveillance and program evaluation
C. Definition of population, intervention strategies, initiation of intervention,
surveillance and program evaluation
D. Definition of population, initiation of intervention, intervention strategies,
surveillance and program evaluation
10 (vi). As a Family Physician, you may want to address all thefollowing questions
regarding diabetes in COPC except:
A. What is the contribution of diabetes to the mortality and morbidity of the population?
B. What is the population’s knowledge about diabetes, obesity and exercise?
C. How does control of an individual’s blood sugar control affect the community?
D. How many diabetics are treated and how many are being adequately controlled?
*****
10
(LI 0216) M.MED.FAMILY MEDICINE (Sub Code: 4014)
SECOND YEAR THEORY EXAM– FEBRUARY 2016
QP .CODE: 434014
Time: Three hours Maximum Marks: 100
INSTRUCTIONS

• Part A will be descriptive type questions based on case scenarios. (40 marks)
• Part B will have Objective type EMQs Extended Matching Questions. (60 marks)
C, D and so on.
Example:
3. THEME –COMMON PSYCHIATRIC PROBLEMS [QUESTIONS. 3(i) – 3(vi)] (6Marks)
Options:
A. Inj. Haloperidol
E. Tab. Diazepam
F. Tab. Lithium
H. Tab. Risperidone
3(ii) F
3(iii)
3(iv)
3(v)
9 Each option may be used more than once. 3(vi) Some
options may not be used at all.
1
PART – A
1. Dr. Nityanand is a Private Practitioner who has established practice in a sub-urban region. He
has a trained Family Physician Assistant working with him. He is keen to implement the ‘Team
Concept’ in Family Practice. He seeks your advice on the following: (Total: 20 Marks)
A. Explain the benefits of Team Care. (5 Marks)

B. What are the things that a Family Physician Assistant can alone do in your Family
C. What are the things that a Family Physician Assistant can do along with the Physician in
your Family Practice? (7 Marks)
2. Dr. Sudha is a Family Physician working with the Government in a primary health care
centre. She takes care of a total population of 10,000. Around 40% of her patients in your clinic
need chronic disease care. (Total: 4 x 5 = 20 Marks)
A. What are the components of Chronic Disease Management in Primary care?

B. Describe the ‘Team Concept’ in the management of chronic disease?
C. How do you ensure compliance of a patient with chronic disease?
D. How can we promote the individual’s capacity to manage the disease?
PART – B
1. THEME: BIO MEDICAL ETHICS [QUESTIONS. 1(i) - 1(vi) (Total: 6 Marks)

Options:
A. Beneficence
B. Non-maleficence
C. Autonomy
D. Justice
Questions:
1.(i) Dr. Kapil works in a District Hospital and all of a sudden a few road traffic accident
victims were brought in. Dr Kapil was attending to them when the local MLA brought his wife
who had migraine. He threatened that if Dr. Kapil did not attend to his wife immediately, he will
report to the Deputy Director of health services. But Dr. Kapil stabilised the accident victims and
only then attended the MLA’s wife. What principle of bioethics was followed here?
2
1(ii). Dr. Kapil then went for his ward rounds and there was Mr. Babu who is being treated for
chronic obstructive pulmonary disease with respiratory failure and Dr. Kapil found that he was
deteriorating. Mr. Babu requested Dr. Kapil to discharge him so that he could die peacefully at
home. Dr. Kapil honoured his request and 2 days later he peacefully died at home. What
principle of bioethics was followed here?
1.(iii) Dr. Kapil allotted a kidney from a brain-dead patient to 25 year old Mr. Kumar with renal
failure though he was offered a huge sum by the relatives of 80 year old Mr. Nandhir who had
severe Diabetic nephropathy and was on dialysis. What principle of bioethics was followed here?
1.(iv) Mr. Raj has come with symptoms of dysuria and fever. After making a diagnosis of
uncomplicated UTI, though Mr. Raj could be treated with antibiotics the physician admits him
1.(v) When Mr. Murugan had a left sided subdural hemorrhage which needed surgical
evacuation, his cranium was opened on the right side by the neurosurgeon. What principle of
bioethics is not taken care of here?
1.(vi) When Mr. Mani who had colonic cancer was advised resection and colostomy, he refused.
His doctor explained about the outcomes and discussed about the alternate modes of treatment.
What ethical principle comes into play here?
2. THEME – CHARACTERISTICS OF A FAMILY PHYSICIAN [QUESTIONS. 2(i) –

From the options ‘A to G’ given below, choose the best answer for questions 2 (i) – 2 (vi)
Options:
A. Coordinated care E. Continuity of care

B. Comprehensive care F. Whole person care
C. High level of Diagnostic and therapeutic G. Good command of complexity and
skill uncertainty
D. Disease centeredness
Questions: What characteristics does Dr. Kapil portray in each of the scenarios described
below?
2(i). 7 year old Gina presented with high grade fever with right knee swelling and pain for
1day. Dr. Kapil suspected that she has septic arthritis and did a knee aspiration and sent it to
lab and confirmed the diagnosis. He started her on appropriate antibiotics because the family
could not afford referral and the child is better now.
3
2(ii). Mr. Govind has come to Dr. Kapil with complaints of giddiness and his BP was found to
be high in repeated occasions. Dr. Kapil explains to him about the disease and starts on
medications. He has also asked him to come back after 15 days for review.
2(iii). 2 year old Fiona was brought by her mother to Dr. Kapil because she was worried that
she is not like other kids. Dr. Kapil did developmental screening and found her milestones
were delayed and then referred her to a developmental pediatrician.
2(iv). Mrs. Sharada presented to Dr. Kapil with a history of aches and pains for the past 6
months. On questioning her, he found that her main problem is her husband who is an
alcoholic and gives her lot of trouble. Dr. Kapil decided to call her and her husband along
with her mother in law who lives with them to have a family conference.
2(v). Dr. Kapil always assigns every second Thursday afternoon for ophthalmic examination
of his diabetic patients and he arranges for an ophthalmologist to come to his clinic and see
them.
2(vi). Dr. Kapil refers Mr. Ganesh who has been diagnosed to have Lung cancer to a
pulmonologist. The pulmonologist is worried about all the complications he may develop
and advises expensive treatments, but the family is finding it impossible to comply as they
are struggling to make ends meet. What characteristic do you see in the pulmonologist
which is not seen in a good Family Physician?
3. THEME – RESPONSIBILITIES OF A FAMILY PHYSICIAN [QUESTIONS. 3(i) –

From the options ‘A to F’ given below, choose the best answer for the questions 3 (i) – 3 (vi)
Options:
A. Maintaining good health D. Maintaining good medical practice
B. Providing Good clinical care E. Working with colleagues
C. Exhibiting Honesty F. Teaching and training
Questions: What responsibilities of a Family Physician are portrayed in each of the

3(i). Mrs. Radha told Dr. Kapil that she has aches and pains. By taking a detailed history and
doing a thorough clinical examination, Dr. Kapil diagnosed her to have depression. He took
time to educate her and gave her some resources to read.
3(ii). Dr. Kapil is busy in his District Hospital but keeps himself updated by gathering
information from the journals, internet resources like Pub-med etc….
3(iii). Dr. Kapil makes sure that the clinical meeting happens every week so that the nurses,
nursing students and the paramedical update their clinical learning.
4
3(iv). Dr. Kapil makes it a point to communicate well with his cleaner, attender, lab technician
and the nurses so that the work is done smoothly.
3(v). Many pharmaceutical representatives visit the District Hospital. One such representative
requested Dr. Kapil to prescribe a new anti-diabetic drug which is more expensive to his
patients and in-lieu, offered him a free trip to Singapore but Dr. Kapil refused.
3(vi). Dr. Kapil wakes up at 5.30 AM and does regular physical exercise for 30 minutes. He
avoids sweets and junk foods and includes a lot of fruits and vegetables in his diet.
4. THEME: ROLES OF A FAMILY PHYSICIAN [(QUESTIONS. 4(i) – 4(vi)]

(Total: 6 Marks)
From the options ‘A’ to ‘F’ given below, choose the best answer for the questions 4(i) – 4(vi)
Options:
A. Health advocate D. Medical expert
B. Role model E. Scholar and teacher
C. Communicator F. Collaborator
Questions:
4.(i) 10 months old Vanitha is brought with vomiting, loose stools for 2 days. Dr. Kapil took a
proper history, examined her and diagnosed her to have some dehydration and started the plan B
treatment with ORS. He also started her on T. cotrimoxazole since she had blood in her stools.
The role exhibited by Dr. Kapil is
4.(ii) Mr. Sunder was under Dr. Kapil’s care. He had oliguria for the past 4 hours which Dr.
Kapil was correcting. He called Mr. Sunder’s son and explained the situation clearly and
informed him that if he is not putting out enough urine in the next few hours, Mr. Sunder may
have to be shifted to a higher Centre where there is dialysis facility. The role exhibited by Dr.
Kapil is
4.(iii) Four hours later, there was not enough urine output still. So Dr. Kapil called the
Nephrologist at the higher Centre and explained and referred Mr. Sunder. He also told the nurse
to call the ambulance driver and shift him at the earliest. The role exhibited by Dr. Kapil is
4.(iv) When Dr. Kapil saw that many people from the local factory came with injuries from the
machinery, he went to the factory owner and asked him to install basic safety equipment. The
role exhibited by Dr. Kapil is
4.(v) Dr. Kapil takes regular classes for the Nursing, Physiotherapy and Occupational therapy
students posted in his District Hospital from the local Medical College. The role exhibited by Dr.
Kapil is
5
4.(vi) Dr. Kapil takes care about his posture and always tries to maintain an erect posture while
sitting in the clinic. He feels that only then can he advise his patients about back care. The role
exhibited by Dr. Kapil is
5. THEME – HEALTH INFORMATICS [QUESTIONS. 5(i) – 5 (vi)] (Total: 6 Marks)

From the options ‘A to H’ given below, choose the best answer for the questions 5 (i) – 5(vi)
Options:
A. Data entry E. Data retrieval
B. Training of staff F. Data analysis
C. Data Security G. Data Reporting
D. Power back up H. Data Collection
Questions:
5.(i) One day, when Dr. Kapil entered his office in the night, he saw his ward boy sitting in
front of the computer. When he reached near him, he found that he was gathering information
about a patient about whom his friend wanted to know. Which aspect of clinical information
storage is weak here?
5.(ii) Dr. Kapil had volunteered to participate in the pilot project to install the new clinical
information system. During the implementation stage, he made sure that the technical person
taught all his people about how to use the various tools in the software and told him to come
once a month so that they can clear all their doubts with him. Which aspect of clinical
information storage is strong here?
5.(iii) Dr. Kapil has ensured that the name, sex, date of birth, vaccination history, height,
captured into the system. Which aspect of clinical information storage is strong here?
5.(iv) The systems in Dr. Kapil’s clinic do not allow reception staff to access the clinical
records at all. Which aspect of clinical information storage is strong here?
5.(v) Dr. Kapil, after running this pilot for some time, wanted to know how many patients
registered in his clinic from a particular area of the town are overweight/obese. He was
impressed when he could get this data within 30 seconds. Which aspect of clinical information
storage is strong here?
5.(vi) Dr. Kapil was also impressed to see the pilot project involved an investment of Rs. 2
lakhs on solar panels for uninterrupted power supply for the hospital clinic. Which aspect of
clinical information storage is strong here?
6. THEME: HOME VISITS [(QUESTIONS. 6 (i) – 6vi)] (Total: 6 Marks)

6
Options:
A. Emergency illness home visit D. Assessment home visit
B. Chronic illness home visit E. Hospitalisation follow up home visit
C. Grief support home visit F. Terminal care home visit
Questions: Identify the type of home visit in the scenarios given below:
6.(i) 14 year old Malathi was brought with bruises on her left forearm. Dr. Kapil suspects an
abuse. He makes a home visit to Malathi’s home.
6.(ii) Mr. Gopi had a stroke and was admitted in the hospital 2 weeks ago. Last week he was
discharged. Dr. Kapil, along with the health worker made a home visit to Mr. Gopi’s home.
6.(iii) Mrs. Shanthi is living 100 metres away from Dr. Kapil’s hospital. This morning her saree
caught fire while she was cooking in the kitchen. Her neighbour came running to Dr. Kapil to
come and save her. You are visiting Mrs. Shanthi’s home.
6.(iv) Mr. Rajan had carcinoma colon. He was under Dr. Kapil’s care for the past 2 years. Last
week he passed away. Today Dr. Kapil and the health worker are making a home visit to his
home.
6.(v) Mrs. Sita is an 80 year old grandma under Dr. Kapil’s care. She has diabetes, hypertension
and she had a stroke 6 months ago and has recovered. Dr. Kapil is making a visit to her home
with his health worker.
6.(vi) Mrs. Vanaja had carcinoma lung with secondaries in the liver. She was deteriorating and
Dr. Kapil was giving palliative care to her. This morning Dr. Kapil gets a call from her husband
saying that she was gasping and he visited her home immediately.
7. THEME: FAMILY PHYSICIAN AND COMMUNITY [QUESTIONS. 7(i) – 7(vi)]

(Total: 6 Marks)
Options:
Questions:
7.(i) Dr. Kapil uses a paper based register recall system for follow-up of his diabetic patients.
7.(ii) Dr. Kapil sends a nurse for home-visits to all his patients with coronary artery disease.
7
7.(iii) Dr. Kapil has employed a nurse educator to teach SMBG (Self-Monitoring of Blood
Glucose) to his diabetic patients. Which aspect of chronic disease follow-up he is focusing on?
7.(iv) Dr. Kapil does monofilament testing for his diabetic patients on a routine basis. Which
7.(v) Dr. Kapil has a volunteer team in OPD to have focus group discussions for patients with
diabetes and their relatives. Which aspect of chronic disease follow-up he is focusing on?
7.(vi) In collaboration with the pilot project by the Government, Dr. Kapil is trying out an
Electronic recall system called PCICS to follow his diabetic patients. Which aspect of chronic
disease follow-up he is focusing on?
8. THEME: COPC – [QUESTIONS. 8(i) – 8 (vi)] (Total: 6 Marks)

Choose the single best option for the questions 8(i) – 8(vi).
8.(i) Dr. Kapil works in Bihar. As a Family Physician, he understands how a disease
condition is serious by this indicator:
A. Admission rate
8.(ii) Dr. Kapil, as a doctor in the District Hospital, has to be involved in a lot of primary
care initiatives. As a Family Physician, he understands how common a condition is by this
indicator:
A. Admission rate
8.(iii). When Dr. Kapil views his practice as a "population at risk”, he thinks in terms of
A. Single patient
B. Community
C. Disease profile
D. Both A and B
8.(iv). Dr. Kapil is very much committed to the practice of COPC. The Philosophy of
COPC is
A. Individual is more important than the community
B. Care of community and care of an Individual are two separate entities
C. The care at the individual level takes care of the community
D. One would look to prevent a disease from occurring among high risk individuals rather
than only seeking to improve their treatment.
8
8.(v). The correct sequence of the steps in COPC which Dr. Kapil is so keen about is:
A. Intervention strategies, definition of population, initiation of intervention, surveillance
B. Intervention strategies, initiation of intervention, definition of population, initiation of
intervention, surveillance and program evaluation
C. Definition of population, intervention strategies, initiation of intervention, surveillance
D. Definition of population, initiation of intervention, intervention strategies, surveillance
8.(vi). Dr. Kapil, as a Family Physician tries to address all the following questions
regarding diabetes in COPC except:
A. What is the contribution of diabetes to the mortality and morbidity of the population?
B. What is the population’s knowledge about diabetes, obesity and exercise?
C. How does control an individual’s blood sugar affect the community?
D. How many diabetics are treated and how many are being adequately controlled?
9. THEME: GOVERNMENT PROGRAMS [QUESTIONS. 9(i) – 9(vi)] (Total: 6 Marks)

From the options ‘A to L’ given below, choose the best answer for the questions 9 (i) –
9 (vi)]
Options:
A. Kala Azar control program H. Revised National TB Control Program

B. Dengue and Chikungunya control (RNTCP)
program I. Reproductive and Child Health Program
C. National AIDS control program (RCH)
D. Malaria control program J. Kishori ShakthiYojana (KSY)
Scheme

part of:
9.(i) The maternal mortality where Dr. Kapil works is very high and most women deliver at
home. Dr. Kapil is able to convince his patients to opt for Institutional delivery because of this
program.
9.(ii) The place where Dr. Kapil works is a malaria endemic area. So he operates Vector control
through IRS with DDT up to 6 feet height from the ground twice annually through this program.
9.(iii) Dr. Kapil is able to do ‘Prevention of Parent to child transmission (PPTCT)’ of disease
through this national program.
9
9.(iv) Dr. Kapil has been very disturbed when he saw lot of children in his locality with PEM
(Protein Energy Malnutrition). He is happy because now he is able to arrange Supplementary
feeding of about 300 calories and 10 grams of protein to preschool children and about 500
calories and 25 grams of protein to pregnant and breastfeeding mothers for six days a week
through this national program.
9.(v) Kala Azar is also endemic where Dr. Kapil works. He successfully operates indoor
insecticide spray in endemic areas through this national program.
9.(vi) Dr. Kapil visited his friend Dr. John who works in Kerala, last summer. He found that Dr
John makes use of this national program for Indoor insecticide spray during epidemic months of
June/July
10. THEME: FUNCTIONS OF A FAMILY PHYSICIAN QUESTIONS. 6(i) – 6(vi)]

(Total: 6 Marks)
Options:
A. Working with community E. Empowering people for their own
B. Involves in preventive care health
C. Accountability F. Competent clinician
D. Organizing home visits
Questions: Which function of the Family Physician is portrayed here?
10(i). Dr. Kapil with the help of the social worker maintained the income and expenditure
incurred in running the health camp conducted in his village and presented it to the team.
10(ii). Dr. Kapil has a meeting with all the ward members and the President of the village once a
month to know the felt need of the people and tries to fulfil their needs.
10(iii). Dr. Kapil has also trained the adolescent boys and girls in the locality to give health
education and the women’s self-help group members to distribute Vitamin A and albendazole
to all the Under-five children in his care.
10(iv). Dr. Kapil told his team to go and see Mr. Baskar at home who was suffering from
carcinoma bronchus.
10(v). Dr. Kapil makes sure that the immunization coverage in his area is more than 95%
10(vi). When Mr. Kadhir came with breathlessness Dr. Kapil diagnosed him to have
**********
10
(LJ 0816) M.MED. FAMILY MEDICINE (Sub Code: 4014)
SECOND YEAR THEORY EXAM– AUGUST 2016

PAPER IV – PRINCIPLES OF FAMILY MEDICINE & PRIMARY CARE
QP .CODE: 434014
Time: Three Hours Maximum Marks: 100
INSTRUCTIONS
● The paper will be for a total of 100 Marks.
● Answer all the Questions.
● The Paper has 2 parts – Part A & Part B.
● Part A will be descriptive type questions based on case scenarios (40 Marks).
● Part B will have Objective type EMQs Extended Matching Questions (60 Marks).
✓ This will have 10 sets of these questions.
✓ Each set will have 6 questions.
✓ Each question will carry 1 mark.
✓ Each set has a theme on the top. In each set there are some options given on the top
C, D and so on.
Example:
Options:
A. Inj. Haloperidol
E. Tab. Diazepam
F. Tab. Lithium
G. Inj. Fluphenazinedeconoate
H. Tab. Risperidone
❖ Match each question to a single best option and write it in 3(i)
your paper in the column provided like this: 3(ii)

3(iii)
3(iv)
❖ Each option may be used more than once. Some options may 3(v)
not be used at all. 3(vi)
1
PART – A
1. You are a Private Practitioner who has just completed the distance course in Family
Medicine. You have also sponsored a nurse to be trained as your Family Physician
Assistant and now you are setting up a Family Practice. One of the key concepts you
want to put into your practice is ‘Team Care’. (Total: 20 Marks)
A. Why team care? Explain the benefits of Team Care. (4 Marks)

B. What is Team care? Explain in brief. (3 Marks)
C. What are the things that a Family Physician Assistant can alone do in your Family
D. What are the things that a Family Physician Assistant can do along with the Physician
in your Family Practice? (5 Marks)
2. You have a primary health care setup in a village. You take care of 6 villages with a
total population of 8000. Around 50% of the patients in your clinic need chronic disease
care. (Total: 20 Marks)
A. What are the chronic diseases should be monitored Primary care? (4 Marks)
B. What are the steps in management of patients with chronic disease? (6 Marks)
C. How do you ensure compliance of a patient with chronic disease? (5 Marks)
D. How can we promote the individual’s capacity to manage the disease? (5 Marks)
PART – B
1. THEME: ROLES OF A FAMILY PHYSICIAN [(QUESTIONS. 1(i) – 1(vi)]

(Total: 6 Marks)
From the options ‘A’ to ‘J’ given below, choose the best answer for the questions 1(i) –
1(vi)
Options:
A. Health advocate F. Collaborator
B. Role model G. Manager
C. Communicator H. Professional
D. Medical expert I. Friend
E. Scholar and teacher J. Philosopher
Questions:
1(i). 8 months old Baby Dora is brought with vomiting, loose stools for 2 days. Dr. Aravind
took a proper history, examined her and diagnosed her to have some dehydration and started the
2
plan B treatment with ORS. He also started her on T. Cotrimoxazole since she had blood in her
stools. The role exhibited by Dr. Aravind is
1(ii). 76 years old Mr. Ravi was under Dr. Ernest’s care. He had oliguria for the past 4 hours
which Dr. Ernest was correcting. He called Mr. Ravi’s son and explained the situation clearly
and informed him that if he is not putting out enough urine in the next few hours, Mr. Ravi may
have to be shifted to a higher Centre where there is dialysis facility. The role exhibited by Dr.
Ernest is
1(iii). Four hours later, there was not enough urine output. So Dr. Ernest called the Nephrologist
at the higher Centre and explained and referred Mr. Ravi. He also told the nurse to call the
ambulance driver and shift him at the earliest. The role exhibited by
Dr. Ernest is
1(iv). Dr. Sampath is working in a factory as a medical officer. He saw many people from the
local factory came with injuries from the machinery; he went to the factory owner and asked
him to install basic safety equipment. The role exhibited by Dr. Sampath is
1(v). 35 years old Dr. Kalaiselvi used to take regular classes for the Nursing, Physiotherapy and
Occupational therapy students posted in her unit. The role exhibited by Dr. Kalaiselvi is
1(vi). 42years old Dr. Meena always tries to sit erect while sitting in the clinic. When asked she
told that then only she can advise her patients about back care. The role exhibited by Dr. Meena
is
2. THEME:RESPONSIBILITIES OF A FAMILY PHYSICIAN [QUESTIONS2(i) –2(vi)]

(Total: 6 Marks)
From the options ‘A to J’ given below, choose the best answer for the questions 2 (i) –
2 (vi)
Options:
A. Maintaining good health F. Teaching and training
B. Providing Good clinical care G. Health advocacy
C. Exhibiting Honesty H. Leadership style
D. Maintaining good medical practice I. Coordinating care
E. Working with colleagues J. Manager
Questions: What responsibilities of the Family Physicians are portrayed in each of the
2(i). 40 years old Mrs. Gunavathi came to see Dr. Khan for her body aches and pains. By taking
a detailed history and doing a thorough clinical examination, Dr. Khan diagnosed her to have
depression. He took time to educate her and gave resources to read.
2(ii) 60 years old Dr. Nandhu keeps himself updated by gathering information from the journals,
internet resources like Pub-med etc….
2(iii) 35 years old Dr. Jacob makes sure that the clinical meeting happens every week so that the
nurses, nursing students and the paramedical update their clinical learning.
2(iv) 42 years old Dr. Oliver communicates well with his cleaner, attender, lab technician and the
nurses so that the work is done smoothly.
2(v) The pharmaceutical representative requested Dr. Ivan to prescribe the new drug which is
costlier to his patients and offered him a free trip to Singapore but he refused.
2
2(vi) 56 years old Dr. Albert is not a diabetic or hypertensive. He wakes up at 5.30 AM and does
regular physical exercise for 30 minutes. He avoids much sweets and junk foods and includes a
lot of fruits and vegetables in his diet.
3. THEME: BIO MEDICAL ETHICS [QUESTIONS. 3(i) - 3(vi) (Total: 6 Marks)

From the options ‘A to I’ given below, choose the best answer for the questions 3(i) –
3(vi)
Options:
A. Beneficence E. Paternalism
B. Non-maleficence F. Medical Indications
C. Autonomy G. Patient Preferences
D. Justice H. Quality of Life
I. Contextual Features
Questions: What is the Bio medical ethical principle involved in each of the following
scenarios?
3(i). Dr. Kannan, the PHC medical officer was attending Mr. Suresh, a victim of road traffic
accident. The local MLA brought his wife who had migraine and on seeing Suresh, the MLA felt
that he was not sick. He threatened that if Dr. Kannan did not attend his wife immediately, he
will report to the Deputy Director of health services. Dr. Kannan stabilised Mr. Suresh and then
only attended the MLA’s wife.
3(ii). Mr. Babu was having chronic obstructive pulmonary disease with respiratory failure and he
was deteriorating. He requested Dr. Madan to discharge him so that he could die peacefully at
home. Dr. Madan honoured his request and 2 days later he peacefully died at home.
3(iii). Dr. Kamesh allotted a kidney from a brain dead patient to 25 year old Mr. Kumar with
renal failure though he was offered a huge sum by the relatives of 80 year old Mr. Nandhir who
had Diabetic nephropathy.
3(iv). 12 year old Ganesh needed an appendicectomy. Dr. Uday knew that his parents may not
be able to pay his fees if operated in his private nursing home. So he arranged for the surgery to
be done free of cost.
3(v). Mr. Shankar was posted for right hernioplasty. Dr. Ratnam by mistake has done left
hernioplasty. What ethical principle is violated here?
3(vi). Dr. Kamala forced Mrs. Saroja to have cu-T inserted though Mrs. Saroja preferred oral
contraceptive pill than cu-T. What ethical principle is violated here?
4. THEME: MEDICAL ETHICS [QUESTIONS. 4(i) - 4(vi) (Total: 6 Marks)

From the options ‘A to T’ given below, choose the best answer for the questions 4 (i) – 4
(vi).
Options:
A. T. Voveran 50 mg tid F. Can be prescribed
B. After the treatment G. Minimum 5 years
C. Ethical H. Unethical
D. Before the treatment I. T. Diclofenac sodium 50 mg tid
E. During the treatment J. Minimum 60 hours every 5 years
2
K. Minimum 3 years P. At least 30 hours every 3 years
L. 48 hours Q. Diclofenac sodium 50 mg tid
M. Minimum 30 hours every 5 years R. Diclofenac sodium 1 tablet tid
N. 72 hours S. No fee for treatment
O. Minimum 4 years T. 24 hours
Questions:
4(i). According to the code of Medical ethics, to maintain a good medical practice, a time
duration a physician is expected to participate in professional meetings as part of continuing
4(ii). According to the code of Medical ethics, how many years is a physician expected to
4(iii). According to the code of Medical ethics, within what period of time is any request made
for medical records by the patient/authorized authority be duly acknowledged and document be
issued?
4(iv). Mr. Ganesh has come with osteoarthritis of knees. Dr. Govindan is planning to give a
4(v). According to the code of Medical ethics, the time to announce the physician’s fees to the
patient for rendering a service is
4(vi). According to the code of Medical ethics, the time to announce the physician’s fees to
5. THEME: CHARACTERISTICS OF A GOOD LEADER [QUESTIONS 5(i) – 5 (vi)]

(Total: 6 Marks)
From the options ‘A to J’ given below, choose the best answer for the questions 5 (i) –
5(vi)
Options:
B. Commitment G. Self-discipline
E. Generosity J. Managing finance
scenarios portray?
5(i). When there is a team meeting, Dr. Lal gives the introduction and then lets the team
members talk about the issues where he observes and give just inputs occasionally.
5(ii). Dr. Mathew plans his day ahead and as far as possible adhere to it. The hospital staff who
5(iii). When the primary care team arranged a health camp, Dr. Kailash called all his staff and
explained to them all what needed to be done and how they were going to do that.
2
5(iv). Mr. Kumar, does not take commission from the local labs for referring the patients for
5(v). When 5 months old Kalai needed a referral for her severe pneumonia, Dr. Kumar paid for
5(vi). Dr. Sudha’s team workers feels comfortable working with her because they feel they can
6. THEME: FUNCTIONS OF A FAMILY PHYSICIAN [QUESTIONS. 6(i) – 6(vi)]

(Total: 6 Marks)
From the options ‘A to G’ given below, choose the best answer for the questions 6(i) –
6(vi)
Options:
D. Organising home visits G. Training of health workers
6(i). Dr. Sonu with the help of the social worker maintained the income and expenditure incurred
in running the health camp conducted in his village and presented it to the team.
6(ii). Dr. Arasu has a meeting with all the ward members and the President of the village once a
month to know the felt need of the people and tries to fulfil their needs.
6(iii). Dr. Naveen a PHC Medical officer has trained the adolescent boys and girls in the locality
to give health education and the women’s self-help group members to distribute Vitamin A and
albendazole to all the Under 5s in his care.
6(iv). Dr. Prakash told his team to go and see Mr. Baskar at home who was suffering from
carcinoma bronchus.
6(v). Dr. Chandan makes sure that the immunization coverage in his PHC is more than 95%
6(vi). When Mr. Kadhir came with breathlessness Dr. David diagnosed him to have
7. THEME: HEALTH INFORMATICS [QUESTIONS. 7(i) – 7 (vi)] (Total: 6 Marks)

From the options ‘A to H’ given below, choose the best answer for the questions 7 (i) –
7(vi)
Options:
A. Data entry C. Data Security
B. Training of staff D. Power back up
2
E. Data retrieval G. Data Reporting
F. Data analysis H. Data Collection
Questions:
7(i). When you entered your office in the night you saw your ward boy sitting in front of the
computer. When you reached there without him noticing, you found that he was gathering
7(ii). Dr. Mohan when he installed the new clinical information system he made sure that the
technical person teach all his people about how to use the various tools in the software and told
him to come once a month so that they can clear all their doubts with him. Which aspect of
7(iii). Dr. Ramesh has made sure that the name, sex, date of birth, vaccination history, height,
captured into the system. Which aspect of clinical information storage is strong here?
7(iv). The systems in Dr. Gupta’s clinic do not allow reception staff to access the clinical records
at all. Which aspect of clinical information storage is strong here?
7(v). Dr. Nitin wanted to know how many patients registered in his clinic from a particular area
of the town are overweight/obese. He could get this data within 30 seconds. Which aspect of
7(vi). Dr. Kandan has invested Rs. 2 lakhs on solar panels for uninterrupted power supply for his
clinic. Which aspect of clinical information storage is strong here?
8. THEME: COMMUNITY ORIENTED FAMILY PRACTICE [(QUESTIONS 8(i) –8(vi)]

(Total: 6 Marks)
8(vi)
Options:
A. True
B. False
Questions:
8(i). Clinicians think normally in terms of single patients rather than population groups. Family
physicians have to think in terms of both.
8(ii). Ideally, the family physician should share the same habitat as his patients.
8(iii). Communication with the patient and other team members, Participation, as needed, in
home care/family conferences, Evaluation of quality of care are all components of the
Community Oriented Primary Care (COPC).
8(iv). A home visit can be either diagnostic or therapeutic, and is often a combination of both.
8(v). In COPC, home care and house calls are 2 separate entities.
2
8(vi). Feasibility of intervention and Commonness of a problem are important criteria for
9. THEME:GOVERNMENT PROGRAMS[QUESTIONS9(i)–9(vi)] (Total: 6 Marks)

9(vi)]
Options:
A. Kala Azar control program H. Revised National TB Control
B. Dengue and Chikungunya control Program (RNTCP)
program I. Reproductive and Child Health
C. National AIDS control program Program (RCH)
D. Malaria control program J. Kishori Shakthi Yojana (KSY)
F. Mid-day meal program L. Rashtriya Swastya Bima Yojana
G. Integrated Child Development
Services Scheme
Questions: Identify the Government program:
program.
9(ii). Dr. Vijula , who works in a malaria endemic area, operates Vector control through IRS
with DDT up to 6 feet height from the ground twice annually through this program.
this program.
children and about 500 calories and 25 grams of protein to pregnant and breastfeeding mothers
9(v). Dr. Isaac, who works in a Kala azar endemic area, operates Indoor insecticide spray in
endemic areas through this program.
during epidemic months of June/July
10. THEME: CHRONIC DISEASE FOLLOW UP [QUESTIONS. 10 (i) –10 (vi)]

(Total: 6 Marks)
From the options ‘A to F’ given below, choose the best answer for question 10(i) –10 (vi)
Options:
2
Questions:
10(i). Dr. Pai uses a paper based register recall system for follow-up of his diabetic patients.
10(ii). Dr. Dinakar sends a nurse for home-visits to all his patients with coronary artery disease.
10(iii). Dr. Dutta has employed a nurse educator to teach SMBG (Self-Monitoring of Blood
Glucose) to his diabetic patients. Which aspect of chronic disease follow-up he is focusing on?
10(iv). Dr. Nesan does monofilament testing for his diabetic patients on a routine basis. Which
10(v). Dr. Manjukar has a volunteer team in OPD to have focus group discussions for patients
10(vi). Dr. Punitha, a Family Physician, uses Electronic recall systems like PCICS to follow her
diabetic patients. Which aspect of chronic disease follow-up she is focusing on?
**********
1
(LK 0217) M.MED. FAMILY MEDICINE (Sub Code: 4014)
SECOND YEAR THEORY EXAM – FEBRUARY 2017

PAPER IV–FAMILY MEDICINE AND PRIMARY CARE
QP .CODE: 434014
INSTRUCTIONS
● The paper will be for a total of 100 Marks.

● Answer all the Questions.
● The Paper has 2 parts – Part A & Part B.
● Part A will be descriptive type questions based on case scenarios (40 Marks)
● Part B will have Objective type EMQs Extended Matching Questions. (60 Marks)
✓ This will have 10 sets of these questions.
✓ Each set will have 6 questions.
✓ Each question will carry 1 mark.
✓ Each set has a theme on the top. In each set there are some options given on the top
C, D and so on.
Example:
Options:
A. Inj. Haloperidol
E. Tab. Diazepam
F. Tab. Lithium
H. Tab. Risperidone
❖ Match each question to a single best option and write it in 3(i)

3(iii)
3(iv)
❖ Each option may be used more than once. Some options may 3(v)
not be used at all. 3(vi)
1
PART – A
1. Dr. Venugopal has a growing medical practice and has become famous doctor in his area for
his management and treatment. He is a hard working doctor seeing the patients day and night
with hectic work schedule. As a result his own health has been affected, and recently he was
detected to have hypercholesterolemia. (Total: 20 Marks)
A. List and explain the 9 different roles a Family Physician should play in day to day work.
(10 Marks)
B. What are the Responsibilities that a Family Physician should be committed to ensure
good practice of Family Medicine? (6 Marks)
C. What are the suggestions you can give to Dr. Venugopal to be a good Family Physician?
(4 Marks)
2. Two doctors worked together in a clinic. Dr. Suresh was 55 years old and he doesn’t like
technology to keep the records and preferred paper system. Dr. Nalini was 33 years old and
she liked usage of computers. The clinic decided to invest in a digital clinical management
system. (Total: 20 Marks)
A. Define ‘Health informatics’. What are the advantages of it in primary care? (6 Marks)
B. What are the four areas of health informatics which impact Family Physicians?(4 Marks)
C. List the advantages and disadvantages of using a digital clinical patient data management
system? (6 Marks )
D. Discuss the four important points in managing a clinical information storage system?
(4 Marks)
PART – B
1. THEME: CHRONIC DISEASE FOLLOW-UP [QUESTIONS 1(i)- 1(vi)]

(Total: 6 Marks)
From the options ‘A to F’ given below, choose the best answers for the questions 1(i) to
1(vi)
Options:

C. Looking for complications F. Patient and carer education
2
Questions:
1 (i) You are planning for an organized Chronic disease care in your clinic. What is the first step
in chronic disease follow up?
1(ii) Dr. Hariharan uses an Electronic recall system to follow his diabetic patients. Which aspect
of chronic disease follow-up he is focusing on?
1(iii) Dr. Hariharan sends Mr. S with a diabetic foot ulcer for debridement to a surgeon. Which
1(iv) Dr. Hariharan has a medical assistant in his team who will take care of many aspects
including teaching self-assessment of peak flow of all his asthmatic patients. Which aspect of
chronic disease follow-up he is focusing on?
1(v) Dr. Hariharan does monofilament testing for his diabetic patients on a routine basis. Which
1(vi) Dr. Hariharan has a volunteer team in OPD to have focus group discussions for patients
2. THEME: ETHICAL PRINCIPLES [QUESTIONS 2(i) - 2(vi)] (Total: 6 Marks)

From the options ‘A to H’ given below, choose the best answers for the questions 2(i) to
2(vi)
Options
A. Contextual Features E. Justice
B. Beneficence F. Medical Indications
C. Non-maleficence G. Paternalism
D. Autonomy H. Quality of Life
Questions: What is the Bio-medical Ethical Principle involved in each of the following
scenarios?
2 (i) Mr. Desai, 69 years old, was recently diagnosed to have poorly differentiated lung cancer
originating in the left lung, Stage IV. He sustained a pathological fracture of his right femur. His
family refused surgery saying he was too weak. The doctor said surgery was needed if he was to
walk again.
2(ii) Dr. Devi always attends to her patients in the order of their coming or prior appointment,
regardless of their socio-economic status. She interrupts this order only when any patient has an
emergency.
2 (iii) Anita, a 7 year old girl was diagnosed with acute lymphoblastic leukemia. Her parents
could not afford her treatment. She was referred to the National Cancer Hospital for treatment
by the Family Physician, as her condition was imminently treatable.
2 (iv) Mrs. Joyce, 78 years old, suffered a left hip fracture after a fall. She recovered from the
surgery and was recommended IV zoledronic acid for her o steoporosis as she did not tolerate
oral medicines. She had flu-like symptoms after the first infusion which lasted three months.
She refused further doses saying the treatment made her feel sicker, than the disease. What
should her physician consider in this situation?
2
2 (v) Mr. Dinesh developed a ganglion on the dorsum of his right hand, which became painful
only when he used his right hand for a long time. His surgeon said he should operate it, as it was
the only way in which it could be managed. In stating that he knew better, what quality was the
doctor demonstrating?
2(vi) Dr. Das refused to operate on 10 year old Vikram with dengue, who sustained both-bone
fracture of his right forearm, as his platelet counts were still low and the fractured segments
were not displaced.
3. THEME: GOVERNMENT PROGRAMS [QUESTIONS 3(i) - 3(vi)] (Total: 6 Marks)

From the options ‘A to L’ given below, choose the best answers for the questions 3 (i) to 3
(vi)
Options
A. Kala Azar control program H. Revised National TB Control
B. Dengue and Chikungunya control Program (RNTCP)
program I. Reproductive and Child Health
C. National AIDS control program Program (RCH)
D. Malaria control program J. Kishori Shakthi Yojana (KSY)
E. Special Nutrition Program K. JSY (Janani SurakshaYojana)
F. Mid-day meal program L. RSBY (Rashtriya Swastya
G. Integrated Child Development BimaYojana.)
Services Scheme

part of:
program.
3(ii). Dr. Vijula , who works in Jharkhand, operates Vector control through IRS with DDT up to
6 feet height from the ground twice annually through this program.
this program.
3(v). Dr. Isaac, who works in Chhattisgarh, operates Indoor insecticide spray in endemic areas
through this program.
during epidemic months of June/July.
4
4. THEME: CODE OF MEDICAL ETHICS [QUESTIONS 4 (i) to 4(vi)] (Total: 6 Marks)
From the options ‘A to T’ given below, choose the best answers for questions 4 (i) to 4 (vi)
Options
A. T. Voveran 50 mg tid K. Minimum 3 years

B. After the treatment L. 48 hours
C. Ethical M. Minimum 30 hours every 5 years
D. Before the treatment N. 72 hours
E. During the treatment O. Minimum 4 years
F. Can be prescribed P. At least 30 hours every 3 years
G. Minimum 5 years Q. Diclofenac sodium 50 mg tid
H. Unethical R. Diclofenac sodium 1 tablet tid
I. T. Diclofenac sodium 50 mg tid S. No fee for treatment
J. Minimum 60 hours every 5 years T. 24 hours
Questions:
4.(i). According to the code of Medical ethics, to maintain a good medical practice, a time
duration a physician is expected to participate in professional meetings as part of continuing
4.(ii). According to the code of Medical ethics, how many years is a physician expected to
4.(iii). According to the code of Medical ethics, within what period of time is any request made
for medical records by the patient/authorized authority be duly acknowledged and document be
issued?
4.(iv). Mr. Ganesh has come with osteoarthritis of knees. Dr. Govindan is planning to give a
4.(v). According to the code of Medical ethics, the time to announce the physician’s fees to the
patient for rendering a service is
4.(vi). According to the code of Medical ethics, the time to announce the physician’s fees to
5. THEME: FAMILY PHYSICIAN AS A LEADER [QUESTIONS 5 (i) TO 5 (vi)]

(Total: 6 Marks)
From the options ‘A to J’ given below, choose the best answers for the questions ‘5 (i) to 5
(vi)
Options
B. Commitment G. Self-discipline
E. Generosity J. Managing finance
5
scenarios portray?
5 (i) When there is a team meeting, Dr. Lal gives the introduction and then lets the team
members talk about the issues where he observes and give just inputs occasionally.
5 (ii) Dr. Mathew plans his day ahead and as far as possible adhere to it. The hospital staff who
5 (iii) When the primary care team arranged a health camp, Dr. Kailash called all his staff and
explained to them all what needed to be done and how they were going to do that .
5 (iv) Mr. Kumar, does not take commission from the local labs for referring the patients for
5 (v) When 5 months old Kalai needed a referral for her severe pneumonia, Dr. Kumar paid for
5 (vi) Dr. Sudha’s team workers feels comfortable working with her because they feel they can
6. THEME: COMMUNITY ORIENTED PRIMARY CARE [6 (i) – 6(vi)] (Total: 6 Marks)

From the options ‘A to H’ given below, choose the best answer for the questions 6 (i) – 6
(vi)
Options:
A. Major health risks E. Program evaluation
B. Intervention strategies F. Training community health workers
C. Home visit G. Health promotion at individual level
D. Target population H. Community health indicators
Questions: What is the aspect of COPC we observe here?

6 (i) Mrs. Kartika, known to suffer from schizophrenia, had not come to the primary care centre
for 8 months. What needs to be done in this case?
6 (ii) Dr. Satwik needs to study available statistics, health needs and cultural practices before he
plans to do this.
6(iii) Statistics, health records and chronic disease registers help us to determine…………….
6(iv) One definitely successful way to reach out to the community is by ……………………
6(v) This method helps the community health team to determine the effect of interventions
carried out.
6(vi) The interventions and methodologies used by the community health team depend on
…………
6
7. THEME: TEAM CONCEPT [7 (i) – 7 (vi)] (Total: 6 Marks)
From the options ‘A&B’ given below, choose the best answer for the questions 7(i) – 7(vi):
Options:
A. Clinical Assistant only
Questions: Which of the following can be done by the clinical assistant alone and which
ones he has to do along with the Physician?
7(i). Ask appropriate questions for the problems or symptoms, using the “ODD IF HAPPY”
mnemonic.
7(ii). Review problem list and get patient's update on recent problems
7(iii). Recommend and document appropriate preventive care plan
7(iv). Performs pertinent physical exam and communicates findings.
7(v). Administer MMSE (Mini Mental State Examination)
7(vi). Writes down impressions and plan
8. THEME: HOME VISIT [QUESTIONS 8 (i) TO 8 (vi )] (Total: 6 Marks)

From the options ‘A to H’ given below, choose the best answers for the questions 8 (i) – 8
(vi)
Options
A. Community based care E. Diagnostic home visit

B. Bereavement visit F. Assessment home visit
C. Home care G. Virtual home visit
D. Therapeutic home visit H. Hospitalization follow up home visit
Questions:
8(i) Ms. Padma a village health nurse visits Mr. Ramanand and gives Inj. Procaine penicillin
daily for 5 days. This is an example of ……………….
8(ii) Dr. Raman was urgently called to see Mr. Gopal who was breathless at home. He examines
him and says Mr. Gopal has acute exacerbation of asthma. This is an example of.....…….
8 (iii) Mr. Murugan was recently discharged from the hospital after a Myocardial infarction. Mrs.
Rose the village health nurse visits him at his home. This is an example of ……………….
8(iv) Mr. Saravanan is staying in a distant place and having transportation problems. Dr. Raman
is enquiring about the health problems of Mr. Saravanan and giving instructions to him
through video conferencing. This is an example of…………………
8 (v) Dr. Raman is treating Mrs. Vasantha for her hypertension and diabetes for the past 3 years.
Inspite of his best treatment her blood pressure and blood sugars are not under control. One
day Dr. Raman plans to visit her home to see her. This is an example of.....……
7
8 (vi) Mrs. Julie is a known hypertensive and a diabetic, regularly seeing Dr. Raman for the
treatment. She developed carcinoma of breast and now in her terminal stage. She is
depressed, bedridden and she developed bed sores. Dr. Raman is sending a nurse as well as
sometimes he also visits her home to monitor her, counsel her and to treat the bed sores.
This is an example of ……………….
9. THEME: NUTRITIONAL PROGRAMS [QUESTIONS 9 (i) TO 9 (vi) (Total: 6 Marks)

From the options ‘A to H’ given below, choose the best answers for questions 9(i) to 9(vi)
Options:
A. Integrated Child Development Services E. National Iodine Deficiency Disorders
Scheme Control Program
B. Midday Meal Program F. School Health program
C. Special Nutrition Program (SNP) G. Mountain dwellers health program
D. National Nutritional Anemia H. National program for Children
Prophylaxis Program
Questions:
9(i) Health screening and identifying children with problems like anemia, malnutrition, eye
problems and refer for treatment; Health Education for school children and teachers; Promoting
hygienic practices in schools like hand-washing
9(ii). Aimed at school-going children by providing one meal per day at noontime with goals of
Improving the nutritional status of children; Encouraging poor children, to attend school more
regularly; Providing nutritional support to children of primary stage in drought-affected areas
during summer vacation.
9(iii). It provides supplementary feeding of about 300 calories and 10 grams of protein to
preschool children and about 500 calories and 25 grams of protein to pregnant and breastfeeding
9(iv). This program provides Supplementary nutrition, provision of Vit-A, Iron and Folic Acid,
Immunization, Health check-ups, Referral services, Treatment of minor illnesses; Nutrition and
health education to women; Pre-school education of children in the age group of 3-6 years.
9(v). Under this program, the expected and breastfeeding mothers as well as acceptors of family
planning methods were also provided with iron and folic acid supplements.
9(vi). Health education about managing endemic goiters; targeted at hilly areas
10. THEME: FAMILY PHYSICIAN AND COMMUNITY HEALTH [QUESTIONS.

10(i) - 10(vi)] (Total: 6 Marks)
From the options ‘A & B’ given below, choose the best answer for the questions 10(i) –
10(vi)
Options:
A. True
B. False
8
Questions:
10(i). Clinicians think normally in terms of single patients rather than population groups. Family
physicians have to think in terms of both.
10(ii). Ideally, the family physician should share the same habitat as his patients.
10(iii). Communication with the patient and other team members, Participation, as needed, in
home care, family conferences, Evaluation of quality of care are all components of the
Community Oriented Primary Care (COPC).
10(iv). A home visit can be either diagnostic or therapeutic, and is often a combination of both.
10(v). In COPC, home care and house calls are 2 separate entities.
10(vi). Feasibility of intervention and Commonness of a problem are important criteria for
********
1
(LM 0218) M.MED. FAMILY MEDICINE (Sub Code: 4014)
SECOND YEAR THEORY EXAM–FEBRUARY 2018

QP .CODE: 434014
INSTRUCTIONS
● The paper will be for a total of 100 Marks
● Answer all the Questions
● The Paper has 2 parts – Part A & Part B
● Part A will be Descriptive Type Questions based on case scenarios. (40 Marks)
● Part B will have Objective type EMQs Extended Matching Questions. (60 Marks)
✓ This will have 10 sets of these questions
✓ Each set will have 6 questions
✓ Each question will carry 1 mark
✓ Each set has a theme on the top
✓ In each set there are some options given on the top followed by some questions
✓ The options are lettered using the English Alphabets A, B, C, D and so on.
Example:
Options:
A. Inj. Haloperidol
E. Tab. Diazepam
F. Tab. Lithium
H. Tab. Risperidone
Match each question to a single best option and write it in 3(i)

3(iii)
3(iv)
3(v)
3(vi)
Each option may be used more than once. Some options may
not be used at all.
1
PART – A
1. As primary care physicians, we know we should always work with teams. Discuss the
following questions: (Total: 20 Marks)
A. The team concept is superior to a doctor practicing alone. Give reasons. (3 Marks)
B. What is the heart of the ‘team care’ innovation? (3 Marks)
C. Discuss the outline of team concept in Indian primary care (4 Marks)
D. Briefly discuss Brazilian model of team care in family health program and its impact.
(4 Marks)
E. What are the responsibilities of Family Physician as a leader? (6 Marks)
2. As a family physician doing chronic disease follow-up, discuss the following questions.
(Total: 20 Marks)
A. What are the components of chronic disease management in primary care? Discuss briefly.
(8 Marks)
B. In a chronic disease follow-up, what should happen at each appointment? (6 Marks)
C. How to ensure compliance in patient with chronic disease? (4 Marks)
D. How will you promote the individual’s capacity to manage the disease as a general
practitioner? (2 Marks)
PART – B
1. Theme: Home Visit [Questions 1(i) – 1(vi)] (Total: 6 Marks)

From the options ‘A to G’ given below, choose the best answer for questions 1(i) – 1(vi):
Options:
A. Community based care E. Diagnostic home visit
B. Home based care F. Family conference
C. Palliative home visit G. Family therapy
Questions: Which type of care is portrayed in the following examples?
1(i). Mr. R, who has developed a stroke, is being taken care of by his wife and children, after
being taught by the family physician when Mr. R was admitted in the hospital.
1(ii). Dr. A visits one of the 19 villages in her target area every 2 weeks. She does home visits
and health education for the community with her team.
1(iii). Dr. B was called to see Mr. G at home, who was breathless. On examination, the doctor
diagnoses Mr. G to be in acute exacerbation of asthma.
1(iv). Dr. R visits the house of Ms. H, a teenager, who has depression and had expressed ideas
of self-harm to talk to his parents.
2
1(v). Dr. S visits the family of Mr. L, who has pancreatic carcinoma for adjustment of
medications for his pain every month. Mr. L finds it very comforting than visiting a doctor in a
hospital.
1(vi). Dr. S visits Mrs. J, a 75 year old hypertensive who lives alone to check her BP and
medications.
2. Theme: Government Programs [Questions 2(i) – 2(vi)] (Total: 6 Marks)

From options ‘A to L’ given below, choose the best answer for questions 2(i) – 2(vi):
Options:
A. Kala Azar Control Program H. Revised National TB Control Program
B. Dengue and Chikungunya Control (RNTCP)
Program I. Reproductive and Child Health Program
C. National AIDS Control Program (RCH)
D. Malaria Control Program J. Kishori ShakthiYojana (KSY)
F. Mid-day Meal Program L. RSBY (Rashtriya Swastya BimaYojana)
Scheme
Questions: Identify the Government Program:
2(i). Dr. F is able to convince her patients to opt for institutional delivery because of this
program.
2(ii). Dr. V, who works in an endemic area, operates vector control through IRS with DDT up to
6 feet height from the ground twice annually through this program.
2(iii). Dr. K is able to do prevention of parent to child transmission of disease through this
program.
2(iv). Dr. H when posted in her PHC found lots of children with PEM. Now she is able to
arrange supplementary feeding of about 300 calories and 10 grams of protein to preschool
2(v). Dr. I is able to do free sputum examination for his patients who present with a two week
h/o cough through this program.
2(vi). Dr. J who works in Kerala makes use of this program for Indoor insecticide spray during
epidemic months of June/July.
3. Theme: Health Informatics [Questions 3(i) – 3(vi)] (Total: 6 Marks)

From options ‘A to H’ given below, choose the best answer for the questions 3(i) – 3(vi):
Options:
A. Data entry E. Data retrieval

B. Training of staff F. Data analysis
C. Data Security G. Data Reporting
D. Power back up H. Data Collection
3
Questions:
3(i). When you entered your office in the night you saw your ward boy sitting in front of the
computer. When you reached there without him noticing, you found that he was gathering
3(ii). Dr. M when he installed the new clinical information system made sure that the technical
person taught all his team members about how to use the various tools in the software. He also
told him to come once a month so that they can clear all their doubts with him. Which aspect of
3(iii). Dr. R has made sure that the name, sex, date of birth, vaccination history, height, weight,
BMI and many other important variables of all the patients coming to his clinic is stored in the
system. Which aspect of clinical information storage is strong here?
3(iv). The systems in Dr. G’s clinic do not allow reception staff to access the clinical records at
all. Which aspect of clinical information storage is strong here?
3(v). Dr. N wanted to know how many patients registered in his clinic from a particular area of
the town are overweight/obese. He could get this data within 30 seconds. Which aspect of
3(vi). Dr. K has invested Rs. 2 lakhs on solar panels for uninterrupted power supply for his
clinic. Which aspect of clinical information storage is strong here?
4. Theme: Chronic Disease Follow Up [Questions 4(i) – 4 (vi)] (Total: 6 Marks)

From options ‘A to F’ given below, choose the best answer for the questions 4(i) – 4(vi):
Options:

Questions: Which aspect of chronic disease follow-up is the doctor focusing on?
4(i). Dr. P arranges for an ophthalmologist to visit his clinic where all his diabetic patients
would be present for retinopathy screening.
4(ii). Dr. D sends a nurse for home-visits to all his patients with coronary artery disease.
4(iii). Dr. K has employed a nurse educator to teach SMBG (Self-Monitoring of Blood Glucose)
to his diabetic patients.
4(iv). Dr. N does monofilament testing for his diabetic patients on a routine basis.
4(v). Dr. M has a volunteer team in OPD to have group discussions for patients with diabetes
and their relatives.
4(vi). Dr. P, a Family Physician, uses an Electronic recall system to follow her diabetic patients.
4
5. Theme: Responsibilities of Clinical Assistant & Physician [Questions5 (i) – 5 (vi)]
(Total: 6 Marks)
From options ‘A to C’ given below, choose the best answer for questions 5(i) – 5(vi):
Options:
A. Assistant only C. Physician only
B. Assistant and physician
Questions: For the responsibilities given below choose who among the answer given above
will be performing them.
5(i). Takes history from patient.
5(ii). Confirms verbally all the information already gathered.
5(iii). Review of systems.
5(iv). Updates the problem list.
5(v). Uses the pulse oximeter.
5(vi). Performs pertinent physical examination and communicate findings.
6. Theme: Functions of a Family Physician [Questions 6(i) – 6 (vi)] (Total: 6 Marks)

From options ‘A to G’ given below, choose the best answer for the questions 6(i) – 6(vi):
Options:

D. Organizing home visits G. Training of health workers
6(i). Dr. S with the help of the social worker maintained the income and expenditure incurred in
running the health camp conducted in his village and presented it to the team.
6(ii). Dr. A has a meeting with all the ward members and the president of the village once a
month to know the felt need of the people and tries to fulfill their needs
6(iii). Dr. N, a PHC Medical officer has trained the adolescent boys and girls in the locality to
give health education, and the women’s self-help group members to distribute Vitamin A and
albendazole to all the under 5s in his care.
6(iv). Dr. P has asked his team to go and see Mr. B at home who was suffering from carcinoma
bronchus.
6(v). Dr. C makes sure that the immunization coverage in his PHC is more than 95%
6(vi). When Mr. K came with breathlessness Dr. D diagnosed him to have pneumothorax and
immediately inserted a chest tube and reduced his breathlessness. After 7 days he was
completely normal and he went home happily.
5
7. Theme: Control of Dengue in India [Questions 7 (i) –7 (vi)] (Total: 6 Marks)
From options ‘A to H’ given below, choose the best answer for questions 7(i) –7(vi):
Options:
A. Disease and Vector Surveillance E. Outbreak response
B. Case management F. Capacity building
C. Laboratory diagnosis G. Behaviour Change Communication
D. Vector management H. Inter-sectoral coordination
Questions:
7(i). Dr. R conducts community health education on transmission and clinical features of dengue
periodically in his target area periodically since it is an endemic area.
7(ii). A health team under Dr. R goes from home to home to take a census of the patients
affected by dengue and to inspect for vector breeding sites.
7(iii). Dr. R has taught his team of health workers to look for the signs and red flags of dengue
in patient presenting with fever.
7(iv). Dr. R, though a family physician, works with government health care schemes in
prevention and treatment of dengue.
7(v). Dr. R uses the WHO clinical criteria for diagnosis and management of patients with
dengue.
7(vi). Dr. R makes use of the district referral lab to confirm his clinical diagnosis of dengue.
8. Theme: Roles & Responsibilities of A Family Physician [(Questions 8 (i) – 8 (vi)]

(Total: 6 Marks)
From the options ‘A to J’ given below, choose the best answer for questions 8(i) – 8(vi):
Options:
A. Medical Expert F. Scholar
B. Communicator G. Professional
C. Collaborator H. Role Model
D. Manager I. Friend & Guide
E. Health Advocate J. Philosopher
Questions: What roles and responsibilities do the following Family Physicians fulfill?
8(i). Dr. S, a Family Physician, is very keen on primordial prevention. He prescribes a strict
exercise regimen for his patients. He also displays posters about this all over his practice and the
neighborhood. Every morning you can see him jogging along the seashore regularly, without fail.
8(ii). When Praveen was finishing his 12th grade, his Family doctor, Dr. P, called him and
briefed him on career choices.
8(iii). Dr. S motivated all the people in his locality to give a request to the collector to deal with
the open sewage system in their locality which was causing a lot of health problems to the
residents.
6
8(iv). Dr. M’s patients are greatly benefitted as she closely works with, and uses the expertise
of, nurses, allied health professionals as well as specialists and super-specialists to give quality
patient care.
8(v). Dr. S, is in charge of a Primary Health Centre (PHC). He wisely allocates the budget on a
fair basis to meet the various needs of the PHC, the staff and the patients.
8(vi). When a sick patient died, the relatives started shouting and behaving badly. But when Dr.
K explained and talked to them, they calmed down and went away.
9. Theme: Medical Ethics [Questions 9(i) – 9(vi)] (Total: 6 Marks)

From options ‘A to F’ given below, choose the best answer for the questions 9(i) – 9(vi):
Options:
A. Beneficence D. Justice
B. Non maleficence E. Paternalism
C. Autonomy F. Autocracy
Questions:
9(i). Mr. R has come with symptoms of dysuria and fever. After making a diagnosis of
uncomplicated UTI, though Mr. Raj could be treated with antibiotics, the physician admits him
9(ii). When Mr. M had a left sided subdural hemorrhage which needed surgical evacuation, his
cranium was opened on the right side by the neurosurgeon. What principle of bioethics is not
taken care of here?
9(iii). When Mr. M had colonic cancer and advised resection and colostomy, he refused. His
doctor explained about the outcomes and discussed about the alternate modes of treatment. What
ethical principle comes into play here?
35 year old Mrs. V was diagnosed with carcinoma cervix stage 1. The surgeon did a
hysterectomy and bilateral salpingo oophorectomy but Mrs. V was not explained that her
uterus and ovaries are being removed. “What will she understand? I have done what is good
for her” is the statement of the surgeon.
9(iv). What is this attitude called in medical ethics?
9(v). What is the principle of bio ethics which is not followed in Mrs. V’s case?
9(vi). In a pediatric outpatient clinic, when children are waiting with medical conditions
requiring immediate attention, a local VIP walks in and demands to see the doctor immediately
because his 3 year old daughter has a dark patch on her cheek from birth. What ethical principle
should come into play here, while you handle this situation?
10. Theme: Community Oriented Primary Care [Questions 10 (i) –10 (vi)] (Total: 6 Marks)
From options ‘A to G’ given below, choose the best answer for questions 10(i) – 10(vi):
Options:
A. Surveillance C. Initiation of intervention
B. Intervention strategies D. Definition of population
7
E. Program evaluation G. Health promotion at individual level
F. Training and Working with community
health workers
Questions: What is the aspect of COPC we observe here?
10(i). Dr. S, when started a small clinic in a remote village, she began to get the complete picture
of the whole village, by studying their total population, age, gender distribution, kind of work the
village people did. This enabled her to understand the population she is going to work with.
10(ii). In few months of Dr. S’s practice she found many children less than two years are coming
with severe lower respiratory infection. She visited the community and went from house to house
to study the child rearing practices among the village women. She also studied the breastfeeding
practice and hand hygiene practices followed in that village.
10(iii). From interacting with the village women Dr. S found lot of wrong practices followed in
that area. She arranged for a meeting with the health workers and nearby local medical
authorities to discuss the ways these problems can be handled.
10(iv). Dr. S and her team decide to conduct regular health education sessions for village
women with the help of the villagers and ASHAs. Once a month, an ASHA gathers a group of
women in the village. Dr. S with trained health workers go to the field and conduct health
education on infant and young child feeding practices and good hand hygiene practices.
10(v). Mothers were met at their homes to educate on causes and prevention of pneumonia and
diarrhoea among young children.
10(vi). In six months time Dr. S set out a survey to find out the current child rearing practices
among women of the same village and correlated with the number of pneumonia cases coming
from that village.
**********

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M.MED.

II YEAR THEORY EXAM– AUG 2013

PAPER IV - FAMILY MEDICINE AND PRIMARY CARE

TIME: THREE HOURS MAXIMUM MARKS: 100

• The paper will be for a total of 100 marks.

(ANSWER ALL QUESTIONS)

(ANSWER ALL QUESTIONS)

1. THEME: TYPES OF REFERRALS [QUESTIONS. 1(i) - 1(vi) (TOTAL: 6 MARKS)

A. Interval Referral C. Split Referral

B. Collateral Referral D. Cross Referral

A. Red Flag for Backache

B. Not a Red Flag for backache

flag for Backace

2(ii). Persistent fever

2(iii). History of cancer

2(iv). Unremitting night pain

2(v). Cauda Equina syndrome

2(vi). Early morning pain

A. Plantar Fasciitis D. Tibial stress fracture

A. Anterior Talo-Fibular (ATFL)

A. Screening and Early detection D. Coordinating care with specialists

B. Ensuring compliance E. Promoting self-capacity of patient

C. Looking for complications F. Patient and carer education

6(i). What is the first step in chronic disease follow up?

B. Clinical Assistant with Physician

7(iii). Recommend and document appropriate preventive care plan

7(iv). Performs pertinent physical exam and communicates findings.

7(v). Administer MMSE (Mini Mental State Examination)

7(vi). Writes down impressions and plan.

D. Malaria control program (RCH)

Questions: Identify to which Government program , each of the following components is

8(iii). Prevention of Parent to child transmission of disease is done

A. Whole person care E. A command of complexity and

Questions: Which aspect of Family Medicine do the following cases portray?:

II YEAR THEORY EXAM– FEB 2014

PAPER IV - FAMILY MEDICINE AND PRIMARY CARE

Q.P. CODE: 434014

TIME: THREE HOURS MAXIMUM MARKS: 100

• The paper will be for a total of 100 marks.

(ANSWER ALL QUESTIONS)

B. What are the benefits of team care? (5 Marks )

1. Who are the Beneficiaries

(ANSWER ALL QUESTIONS)

1. THEME – Family physician as Leader [(QUESTIONS. 1(i) – 1(vi)]

C. Good communication G. Self discipline

Questions: Which aspect of good leadership quality of a Family physician do the

A. Whole person care E. A command of complexity and

B. Clinical Assistant with Physician

4 (i) Functions by the mnemonic “ODD IF HAPPY”

4 (iv) Performs pertinent physical exam and communicates findings.

4 (vi) Documenst the impressions and plan of the physician

A. Screening and Early detection

C. Looking for complications

D. Coordinating care with specialists

E. Promoting self-capacity of patient

F. Patient and carer education

5 (i) What is the first step in chronic disease follow up?

A. Community based care

B. Home based care

D. Therapeutic home visit

E. Diagnostic home visit

G. Core value of Family medicine

6(i).Patient-Doctor relationship is a ……………

6(ii).Increasing costs, improvement in communication and emergency services has